Ruptured pseudoaneurysm complicating an infected radial artery catheter: Case report and review of the literature

The authors present the 16th case of a pseudoaneurysm forming at the site o f an infected radial artery catheter and only the third case that presented with rupture and hemorrhage requiring emergent operative repair. Radial ar tery catheters are quite safe, and most infections can be treated effective ly with line removal and intravenous antibiotics. However, two factors corr elate strongly with the subsequent development of pseudoaneurysms. Infectio n with Staphylococcus aureus was seen in 15 of 16 cases, and persistent sig ns of infection lasting more than 48 hours after the institution of antibio tic therapy and line removal were seen in 16 of 16 cases. Therefore, patien ts with S. aureus radial artery line infections with persistence of infecti on more than 48 hours after the induction of treatment are at high risk and should be observed closely for signs of pseudoaneurysm formation. Once a p seudoaneurysm has formed, surgical repair is required. Most recommend ligat ing the artery if there is pulsatile backbleeding from the distal stump and Alien's test shows good perfusion of the hand by the ulnar artery.