Disclosures: Ady M. Correa-Mendoza, MD: Nothing to disclose

Case Description: Right handed patient who underwent transmetacarpal amputation of right first, second and third digits as a complication of radial artery cannulation for coronary angiography. After amputation, patient presented impaired walking balance and decline in functional activities, for which he received balance training. Currently, he is participating in pre-prosthetic training for myoelectric prosthesis placement.

Setting: Rehabilitation Medical Services, ambulatory clinics

Patient: 80-year-old-male, with history of Parkinson’s disease, diabetes mellitus, hypertension and coronary artery disease, who underwent cardiac catheterization via the right radial artery after diagnosis of myocardial infarction. He was found with 3-vessel disease requiring a coronary artery bypass grafting. Subsequently, patient presented gangrenous first, second and third digits of the catheterized hand, secondary to radial artery thrombosis, leading to transmetacarpal amputation.

Assessment/Results: Our patient completed balance therapy and is receiving a pre-prosthetic training for myoelectric prosthesis placement. Through a multidisciplinary approach that is conducted by a group of physicians, psychologist, physical therapists, occupational therapists and prosthetists, the patient has been provided support to overcome this devastating experience. He has demonstrated physical, functional and psychosocial improvement and is gradually reintegrating into society.

Discussion: Recent interventional techniques include the use of radial artery cannulation for coronary angiography. Radial artery thrombosis has an incidence of 8-12%. However, thrombosis complicated with critical limb ischemia requiring amputation has been rarely reported in the literature. Post-operative care should include close monitoring of radial artery patency by means of a detailed physical examination, with the adjuvant use of doppler and/or ultrasound technology. Though rare, critical ischemia after this procedure could lead to partial hand amputation and significant functional impairments.

Conclusion: In order to prevent complications after transradial catheterization procedures, early interventions are fundamental. If complications occur, such as transmetacarpal amputation, patient benefits from a multidisciplinary, intensive rehabilitation program that restores/maximizes his functional recovery.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/case-of-a-transmetacarpal-amputation-secondary-to-radial-artery-thrombosis/