Complications of Arterial Catheterization

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Arterial catheterization (AC) is routinely used during surgical procedures, with significant hemodynamic instability, to allow for continuous blood pressure monitoring. Although AC is generally safe and commonly utilized, the incidence of complications is 9-13% including hematoma, thrombosis, pseudoaneurysm, ischemia, and peripheral nerve injury. Neurological complications are rare and may result from direct needle trauma or compression from access-site hematoma or pseudoaneurysm. Prior reports suggest that compressive neuropathy is the most common mechanism of AC related nerve injury, while direct nerve injury occurs much less frequently and is often associated with prolonged or permanent deficits. It is very important that physicians differentiate between these etiologies since it is critical for prognosis, treatment, and implementation of preventive measures.

We report the case of a 44-year-old male with uncontrolled hypertension and a large biochemically active left adrenal mass consistent with a pheochromocytoma, who underwent open left adrenalectomy with splenectomy. Given the anticipated intraoperative blood pressure liability, invasive monitoring was planned. A left brachial AC was performed pre-induction using ultrasound guidance and the Seldinger technique with successful waveform confirmation and no immediate complications. It is important to consider when placing AC, consistent use of ultrasound guidance, meticulous technique, and vigilance post placement monitoring for developing pain, swelling, or sensory deprivation is important to avoid any iatrogenic injuries.

When postoperative paresthesia follows AC, the differential should include position-related nerve injury, direct nerve trauma, or compression from an access-site hematoma. In this patient, focal swelling with full recovery is consistent with transient compressive neuropathy described in the literature when ischemia is excluded. Progressive neurologic deficits or concerning vascular findings warrant early imaging for hematoma or pseudoaneurysm and timely procedural or surgical escalation to prevent prolonged dysfunction.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2079

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