Complication After Artery Catheterization: Digital Gangrene in a Patient with Myeloproliferative Disease with Thrombocytosis

Abstract

To the Editor: We read with interest about “a case with digital gangrene after artery catheterization in a patient with thrombocytosis” recently published in the Journal (1). In our hospital, we treated a patient with a long history of a myeloproliferative disease with thrombocytosis (782–1410 × 109/L) scheduled for an emergency osteosynthesis of a hip fracture. Three years previously, for major abdominal surgery, an arterial catheter was placed in a radial artery without complications. The patient had a history of a hypertensive cardiopathy with biventricular insufficiency with mild aortal, tricuspidal, and mitral insufficiency; a chronic obstructive pulmonary disease with pulmonal-arterial hypertension; and a long history of smoking. Some weeks before the hip fracture, a livid toe was treated successfully with salicylic. The operation was performed during spinal anesthesia. Because of the cardial risk, an invasive blood pressure monitoring was planned. After several unsuccessful trials on the left side, a catheter (Seldicath 3F, 8 cm; Plastimed, Saint-Leu-La-Forêt Cedex, France) was placed without problems into the right radial artery. The catheter was removed immediately after the termination of the operation. Several hours later, the patient complained of pain and livid coloration in her little right finger. In the arteriography of the upper extremity, the ulnar artery was missing distally of the forearm, the puncture site showed no stenosis, and the perfusion of the hand and fingers showed older and newer thromboembolic formations with collaterals and no perfusion of digit V. This finger had to be amputated 1 wk later. The two patients are rather similar as to their medical history with a myeloproliferative syndrome with massive thrombocytosis and a high probability of generalized arteriosclerosis. Both had an arterial thrombosis after arterial catheterization, which ended in an amputation. We conclude that such patients have a much higher risk of arterial occlusions after arterial catheterization. Therefore the indications of an invasive blood pressure monitoring have to be evaluated very carefully, and the arterial catheter should be placed in a large vessel. Prophylactic salicylic acid is recommended. Brigitte Ulrich MD Georg Kreienbühl MD