Management of thrombotic complications of invasive arterial monitoring of the upper extremity.

Invasive arterial monitoring is essential intraoperative and perioperative management of vascular and cardiac patients. Complications resulting from arterial monitoring, although rare, can result in severe functional sequelae and loss of an extremity. Severe extremity ischemia and repeated thromboses in a 10-year-old male resulted from brachial arterial monitoring line. Multiple operative thrombectomies and systemic anticoagulation were unsuccessful. Limb salvage and arterial patency were achieved by saphenous vein patch angioplasty at site of arterial injury and intermittent intra-arterial streptokinase infusion placed into a natural side branch of the saphenous vein segment. Although many complications may result from arterial monitoring, the most serious is arterial thrombosis with impending digital or extremity gangrene. This constitutes a surgical emergency. When aggressive conventional surgical techniques alone fail to control catheter induced thrombosis, an innovative technique in combination with regional intra-arterial streptokinase therapy has been successful adjunctive measure in reestablishing microvascular patency resulting in limb salvage.