Volume 50, Issue 1 Spring 2026 JVU 501-23 | Radial Artery Injury: Diagnosis and Surgical Repair, Following Catheter Placement for Hemodynamic Monitoring-Radial Artery Injury: Diagnosis and Surgical Repair, Following Catheter Placement for Hemodynamic Monitoring

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

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This case report details a rare but serious complication of radial arterial line placement—forearm compartment syndrome due to radial artery injury. Radial arterial lines are commonly used for hemodynamic monitoring in critically ill patients or those undergoing invasive cardiac procedures and are generally considered safer compared to femoral or brachial artery access. However, adverse outcomes such as hemorrhage leading to compartment syndrome, though rare, can occur.<br /><br />An 83-year-old man with a complex cardiac history underwent atrial fibrillation cryoablation with left radial artery access attempted multiple times. Despite successful line placement in the right radial artery and an uneventful procedure, he developed left forearm pain, swelling, and neurological symptoms shortly after. Initial bedside exams suggested possible nerve irritation or compression with soft forearm compartments and improving symptoms. He was discharged after apparent resolution.<br /><br />Nine days later, he presented with persistent severe forearm pain, extensive bruising extending from wrist to upper arm, and impaired finger mobility. Duplex ultrasound revealed a patent left radial artery with extraluminal flow consistent with a 1.5 x 2.0 cm pseudoaneurysm and a large intramuscular hematoma causing compartment syndrome. Computed tomography angiography confirmed these findings.<br /><br />The patient underwent urgent surgical intervention, including left forearm fasciotomy, carpal tunnel release, and primary radial artery repair. Postoperatively, he had near-complete wound healing but continued to experience neuropathy and hand weakness at six months.<br /><br />This report emphasizes the importance of early recognition of complications after radial artery cannulation, particularly when patients exhibit persistent pain, swelling, or neurological deficits. It highlights the pivotal role of duplex ultrasound in diagnosing arterial pseudoaneurysm and guiding timely surgical management to prevent irreversible nerve and muscle damage from compartment syndrome. Though radial artery access is associated with low complication rates, vigilance and prompt imaging in symptomatic patients are crucial to avoid serious outcomes.

Keywords

radial arterial line

compartment syndrome

radial artery injury

forearm pain

pseudoaneurysm

intramuscular hematoma

duplex ultrasound

fasciotomy

carpal tunnel release

neuropathy