Perioperative arterial catheterization: A prospective evaluation of ultrasound, infection, and patient-focused outcomes.

BACKGROUND: There is little information regarding complications of arterial catheterization in modern clinical care. We aimed to determine the incidence of abnormal duplex vascular ultrasound and catheter related infections following perioperative arterial catheterization. METHODS: Patients requiring arterial catheterization for elective surgery were included and insertion details collected prospectively. Duplex ultrasound evaluation was performed 24 h after catheter removal. Symptomatic patients were identified by self-reported questionnaire. On Day 7, patients answered questions by telephone, related to the insertion site, pain, and function. Results of catheter tip and blood culture analyses were sought. Univariate associations of patient and surgical characteristics with abnormal ultrasound were assessed with p < 0.05 considered significant. RESULTS: Of 339 catheterizations, 105 (40%) had ultrasound evaluation. Catheters were indwelling for median (IQR, range) duration of 6.0 h (4.4-8.2, 1.8-28) with no catheter-related infections. There were 16 (15.2%, 95% CI 9.0%-23.6%) abnormal results, including 14 radial artery thromboses, one radial artery dissection, and one radial vein thrombosis. Those with abnormal ultrasound results were more likely to have had Arrow catheters inserted (68.8% vs 27%, p = 0.023) and more than one skin puncture (37.5% vs 26.8%, p = 0.031). Two of the 16 (12.5%) patients with abnormal ultrasound results reported new symptoms related to the hand compared with nine of the 88 (10.2%) with normal results (p = 0.1). No patients required urgent referral for management. CONCLUSIONS: Thrombosis was the most common abnormality and was usually asymptomatic. There were no infections, few post-operative symptoms, and minimal functional impairment following arterial catheterization.

Symptomatic infrarenal aortic aneurysm sac expansion 5 years post-endovascular repair without an identifiable endoleak.

A 71-year-old male presented with a symptomatic expanding 11 cm infrarenal aortic aneurysm 5 years post-endovascular aortic repair. Duplex ultrasound and angiography showed no identifiable endoleak but confirmed an enlarging aneurysm sac with a new saccular configuration. The ultrasound findings were particularly unusual in that the aneurysm sac was a mixture of hardened echogenic material and an anechoic fluid-like substance, with the echogenic material appearing to float around the sac with gravitational dependence. Open surgical intervention was performed. The aneurysm appeared pressurised with forceful expulsion of the sac contents post-incision, though again no endoleak was identified. The sac contents were confirmed as a mixture of clear fluid and hardened haematoma. At 6 weeks follow-up there was complete return of the aneurysm sac almost to its pre-open surgery state. Multiple endoleak theories were considered from initial imaging through to follow-up.