Extremity Amputation following Radial Artery Cannulation in Patient with Craniectomy

경피요골동맥삽관후 발생된 수지괴사 1례

The technique of radial artery cannulation and its complications are well documented, but serious complications are rare. This is a report of one case of amputation of wrist due to finger necrosis developed from the radial artery cannulation in patient who had craniectomy surgery. This 52-year-old 70kg male underwent subdural hematoma removal surgery. Right radial artery cannulation was carried out percutaneously using 22 gauge Teflon extracath needle after modified Allen's test appeared to be positive. It was intermittently flushed by heparinized solution. His arterial blood pressure was maintained 100/70 - 110/80mmHg and 5 units of banked whole blood and 1 unit of fresh frozen plasma were transfused during 8-hours operation. Cannula was removed on the 9th hour after operation because that was obstructed. On the 12th hour after removal of cannula, his right hand noted to be cool and cyanotic. So, warm towel and hot bag applied continuonsly on the right hand and the right stellate ganglion block was carried out everyday for 4 times. However, on the 10th day after removal of cannula, necrotic change of all fingers of the right hand became worse and skin of fingers were shrunken. Therefore, disarticulation of the right wrist carried out on the 71th day of his hospitalization.

경피요골동맥삽관후 수지괴사가 발생되어 손목을 절단한 1례를 보고하며, 동맥삽관후 수지괴사가 유발될 수 있는 요인으로는 사용된 카테터의 크기, 종류, 천자횟수, 삽관거치기간 및 카테터삽관후 유지방법외에도 환자의 혈액구성성분변화, 혈액응고장애, 심박출량감소상태, 성별 등을 들 수 있으며, 본원에서 발생된 예에서는 수술후 환자가 심히 움직여 끈으로 동맥삽관된 손목을 침대에 묶어 놓음으로써 카테터에 의한 혈관손상이 심했음이 가장 큰 원인일 것으로 추측되며 그 외에도 혈액성분변화 및 응고장애에 의해 심한 혈전형성이나 heparin용액의 간헐적 관류시 발생될 수 있는 혈전의 전색도 가능성이 있을 것으로 사료된다.