Complications of Brachial Artery Catheterization: Prospective Evaluation with the Doppler Ultrasonic Velocity Detector

¹ Associate Professor of Surgery and Director, Peripheral Vascular Laboratory, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City
² Division of Peripheral Vascular Surgery, Department of Surgery and the Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle
³ Professor of Surgery and Director, Division of Peripheral Vascular Surgery

A prospective evaluation of catheter-induced arterial injury was carried out in 100 consecutive patients who underwent 104 cardiac catheterizations via the brachial artery. The Doppler ultrasonic velocity detector was utilized to noninvasively assess brachial, radial and ulnar arterial signals and pressures. Brachial artery obstructions occurred in 18 patients (17 percent), two-thirds of whom had no, or only transient, symptoms of ischemia. Six patients developed palpable pulses during the immediate period after catheterization. Complications correlated with duration of indwelling arterial catheter. The mean arm-forearm pressure gradient was 47 mm Hg (range 20-105), the magnitude of which correlated with symptoms and pulse deficits. Five patients underwent successful thrombectomy, with ablation of the pressure gradient. Five had unsuccessful thrombectomies, but only two had persistent ischemic symptoms, which abated as collateral circulation developed. Eight asymptomatic patients with low pressure gradients were observed. The Doppler ultrasonic velocity detector is a simple noninvasive technique to guide the physiologic assessment and management of complications of arterial catheterization.