Placement of an intra-arterial catheter into an extremity may be associated with distal ischemia. Although rare this can be devastating for the patient. Early diagnosis and aggressive management can be crucial in reducing late complications.


Conditions associated with distal ischemia:

(1) arterial thrombosis or other occlusion

(2) no or poor collateral circulation

(3) severe peripheral vascular disease

(4) vasospasm


Risk factors for peripheral vascular disease:

(1) smoking

(2) diabetes mellitus

(3) hyperlipidemia


Other factors contributing to limb ischemia:

(1) end-stage renal disease

(2) malignancy (which may be associated with a hypercoagulable state)

(3) activated coagulation (DIC, heparin-induced thrombocytopenia, etc.)

(4) shock and/or vasopressors

(5) previous surgery or trauma to the limb


Clinical findings:

(1) loss of distal pulse

(2) paresthesias or pain in the arterial distribution

(3) cyanosis or dusky discoloration

(4) loss of distal sensory and/or motor function

(5) loss of blood flow on Doppler flow or other imaging studies


The extent of ischemia can be categorized as for peripheral artery disease (Rutherford et al):

Extent of Ischemia


viable; no immediate risk of ischemia


marginal threat with minimal sensory loss limited to the fingers


significant risk with motor loss and/or continuous pain at rest





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