Thrombolytic Therapy in the Setting of Arterial Line-Induced Ischemia

Abstract

Purpose:

To evaluate the use of percutaneous transcatheter thrombolysis in the treatment of thrombosis due to radial artery cannulation.

Methods and Results:

Seven patients (4 women; age range 41–62 years) with symptomatic cannulation-induced thrombosis and failure to improve after systemic anticoagulation underwent 8 catheter-directed thrombolytic infusions at our institution over a 3-year period. Access was either antegrade through the brachial artery or retrograde through the femoral artery. Thrombolytic infusions with urokinase began 2 to 12 days (average 6) after removal of the radial artery catheter. The thrombolytic infusion was successful in 5 of 7 patients based on angiographic flow restoration with <20% residual thrombus and significant clinical improvement in the ischemia.

Conclusions:

When systemic anticoagulation has failed, percutaneous catheter-directed thrombolytic infusion appears to be effective in the treatment of most patients with severe ischemic hand symptoms due to thrombosis after radial artery cannulation.

Keywords

Radial artery catheterization complications iatrogenic injury thrombosis hand ischemia thrombolysis urokinase

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