Radial Artery Injury: Diagnosis and Surgical Repair, Following Catheter Placement for Hemodynamic Monitoring

Radial arterial line placement is often utilized for hemodynamic monitoring in critically ill patients or during invasive procedures. This is generally considered safe with a low incidence of complications compared with catheters placed in the brachial and femoral arterial locations. One of the rare adverse outcomes associated with radial artery access is hemorrhage resulting in compartment syndrome. In the following case, duplex ultrasound played a pivotal role in the diagnosis of the cause of forearm compartment syndrome. An 83-year-old male presented to the vascular laboratory 9 days after undergoing a cardiac procedure via left radial artery access. He reported persistent forearm pain, swelling, and reduced finger mobility. Physical examination revealed extensive bruising along the forearm, extending to the medial upper arm above the elbow. Duplex ultrasound revealed a patent left radial artery with evidence of extraluminal arterial flow consistent with pseudoaneurysm and an associated hematoma. He underwent urgent surgical intervention, including left forearm fasciotomy, carpal tunnel release, and radial artery repair. Forearm compartment syndrome due to radial artery injury is a rare but a serious complication of radial line placement for monitoring or procedural access. Delayed recognition can result in severe complications such as irreversible nerve damage and muscle necrosis. This case highlights the important role of duplex ultrasound in the detection of arterial pseudoaneurysm, which can then prompt referral for appropriate surgical management.