Anesth Analg 2006;103:794-795
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000227156.20336.2C
LETTER TO THE EDITOR
Steven L. Shafer
Unusual Complication of Transradial Catheterization
Naga S. Pullakhandam, MBBS,
Zhong-jin Yang, MD,
Sebastian Thomas, MD, and
John Wasenko, MD
Department of Anesthesiology; PullakhN{at}upstate.edu(Pullakhandam, Yang, Thomas)
Department of Radiology; Upstate Medical University; Syracuse, NY (Wasenko)
To the Editor:
Percutaneous transradial coronary angiography has recently increased in popularity with low theoretical risk of complications (1–4). We report a case in which the cardiologists were unable remove a catheter during transradial coronary catheterization. General anesthesia was used to facilitate catheter removal. A 62-yr-old morbidly obese male was scheduled for left heart catheterization. The cardiologists gained access to his right radial artery without difficulty and immediately administered intraarterial verapamil and nitroglycerine. They then passed a guidewire into the brachial artery with a 5F sones catheter over it. However, they could neither advance nor retract the catheter beyond a certain point in the upper arm (Fig. 1). For presumed vasospasm, the cardiologists administered a widely used "antispasmodic cocktail" (isosorbide mononitrate or isosorbide dinitrate or nitroglycerin and verapamil) for radial artery spasm (5–7). They gave additional verapamil, nitroglycerine, papaverine, midazolam, and morphine—all without effect. Cine injections showed the catheter lodged in an artery, either a small branch of the radial artery or a small native radial artery. They consulted a vascular surgeon, who tried without success to dislodge the catheter. We administered general anesthesia in preparation for possible surgical exploration. Soon after we induced anesthesia and intubated the patient's trachea, we could easily pull back the intact, perfectly formed catheter. Our case suggests that general anesthesia, by causing arterial vasodilation, may be a safe, painless way to remove a catheter lodged in an artery in vascular spasm.
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Figure 1. Angio showing the catheter in the artery in vasospasm with the tip of the catheter in the brachial artery.
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