Radial artery pseudoaneurisma due to unintentional arterial puncture during cephalic vein cannulation: A rare case report.

Introduction and importance: Radial artery pseudoaneurysm is considered as an extremely rare and serious complication that usually follows after cardiac catheterizations with incidence of less than 0.05%, but in lesser frequency with arterial cannulation, trauma, and inflammation or hemodialysis therapy. On the other hand, venous access is clinically important, as it allows for blood sampling, administration of medications, fluids, nutrition, and chemotherapy. But its usage is associated with complications like catheter-associated infections, injuries to peripheral nerves, along with thrombosis and phlebitis of the vessel involved as well as arterial injury. Clinical presentation: in this report, we present a 67 years old healthy nonsmoker male patient with proximal radial artery pseudoaneurysm following several attempts of cephalic vein cannulation for intravenous access. Clinical discussion: Radial artery pseudo-aneurisms are very rare with reported incidence of 0.048%, and mainly due to arterial puncture in an attempt of cardiac intervention procedures, but to the authors knowledge this is one of the first reported cases of radial artery pseudoaneurysm caused by arterial puncture in an attempt of cephalic vein cannulation. Conclusion: Radial artery pseudoaneurysm can occur after attempts of cephalic vein cannulation and patients can be successfully managed with surgical removal of the false aneurism and radial arteriorrhaphy.

Furosemide infusion prevents the requirement of renal replacement therapy after cardiac surgery.

OBJECTIVE: Acute kidney injury (AKI) is a devastating complication following cardiac surgery and the ideal management is controversial. This prospective, randomized, open-label and double-blinded study analyzed the renoprotective effects of furosemide infusion and intermittent bolus therapy administered with dopamine infusion in cardiac surgical patients. METHODS: Between August 1, 2007 and July 31, 2008, 100 adult patients undergoing elective coronary artery bypass surgery (CABG) surgery with normal renal function (creatinine <1.4 mg/dl) were enrolled in the study. The patients were randomized for the comparison of intermittent (Group 1, n=50, 1mg-3mg/kg) and continuous infusion of furosemide (Group 2, n=50, 10mg/ml). Continuous variables were expressed as mean+/- SD and compared by unpaired Student's t test or ANOVA for repeated measures. Statistical significance was assumed if p value was <0.05. RESULTS: Renal replacement therapy (RRT) was used in 5% of patients (all in group 1, p=0.028). The 30-day mortality was 5%. Only 2 patients became hemodialysis dependent in group 1. Group 2 patients showed a continuous and higher urine output postoperatively than group 1 (p<0.001). Both groups had significant increase in peak postoperative serum creatinine values (p<0.001), however peak postoperative creatinine-clearance was significantly lower in group 1 (p<0.001). CONCLUSION: Acute kidney injury necessitating RRT makes a small percentage of patients undergoing cardiac surgery and if RRT is not required the survival is excellent. Continuous infusion of furosemide seems to be effective in promoting diuresis and decreasing the need for RRT. However further multicenter studies with different doses of furosemide are required to confirm these results.