- Letter to the Editor
- Open Access
- Published:
Intra-arterial catheter incidentally placed in the median artery in a patient with an anatomical variation of the radial artery
JA Clinical Reports volume 8, Article number: 98 (2022)
To the Editor
The median artery is a persistent primitive artery that accompanies the median nerve and supplies the nerve and the hand [1]. We herein describe a case in which an arterial catheter was incidentally inserted into the median artery in a patient with a superficial radial artery. Fortunately, the patient did not develop a neuropathy; however, puncture of the median artery is associated with a high risk of median nerve injury. Therefore, anesthesiologists must be familiar with the anatomical variations of the median and superficial radial arteries in the forearm and wrist to achieve safe cannulation.
A 61-year-old man was scheduled for open hepatectomy for hilar cholangiocarcinoma. After induction of anesthesia, an anesthesiology fellow was unable to palpably identify the artery on the radial side of the right distal forearm (circle in Fig. 1). She located an artery on the distal forearm using color Doppler and inserted a 20-gauge catheter on the first attempt. The blood was able to be withdrawn via that catheter, and the arterial waveform was normal. An attending anesthesiologist found that, however, the arterial catheter was unexpectedly placed in the median artery, which runs between the flexor carpi radialis tendon and the palmaris longus tendon (Fig. 1). The color Doppler ultrasonography confirmed that the artery ran anterior to the median nerve. After surgery, the patient denied any palmar paresthesia and any difficulty of finger–thumb opposition.
Incidental arterial cannulation of the median artery. An arterial catheter was placed between the flexor carpi radialis (FCR) tendon and the palmaris longus (PL) tendon, at the concordance of the running course of the median nerve. The superficial radial artery, an anatomical variation of the radial artery, was dominant to the radial artery in our patient (red line). Therefore, the pulse was difficult to palpate in the distal forearm where the radial artery usually runs (circle)
The median artery is an embryonic structure that typically regresses by the eighth week of gestation [1]. Moreover, the prevalence of the median artery declines with age, even after birth [2]. An ultrasonographic study showed a persistent median artery in 26% of adults, and the mean diameter of the artery was 1.1 mm (range, 0.5–1.7 mm) [3]. Although incidental cannulation of the median artery was reported in a 1-year-old child [4], this is the first report in an adult. The median artery runs along the anterior aspect of the median nerve [5]. Therefore, penetration of the posterior wall of the median artery is associated with a risk of nerve injury.
The superficial radial artery, an anatomical variant of the radial artery that runs over the anatomical snuffbox, has been reported at a frequency of 0.5 to 1.0% [6]. Our patient had a superficial radial artery with a normal origin of the radial artery, which runs subcutaneously and crosses over the tendons, defining the snuffbox at the wrist level (red line in Fig. 1). The existence of a superficial radial artery implies difficulty detecting the normal radial pulse at the wrist level [7]. Thus, the presence of a radial artery variant was thought to be the main reason for the incidental cannulation in this case.
In conclusion, this case provides two learning points. The first is that the presence of a superficial radial artery results in difficulty detecting the normal radial pulse at the wrist, and the second is that puncturing the median artery is associated with a high risk of injury to the median nerve.
Availability of data and materials
Data sharing is not applicable to this article, as no datasets were generated or analyzed for the report.
References
Lucas T, Kumaratilake J, Henneberg M. Recently increased prevalence of the human median artery of the forearm: a microevolutionary change. J Anat. 2020;237:623–31.
Carry PM, Nguyen AK, Merritt GR, Ciarallo C, Chatterjee D, Park J, et al. Prevalence of persistent median arteries in the pediatric population on ultrasonography. J Ultrasound Med. 2018;37:2235–42.
Gassner EM, Schocke M, Peer S, Schwabegger A, Jaschke W, Bodner G. Persistent median artery in the carpal tunnel: color Doppler ultrasonographic findings. J Ultrasound Med. 2002;21:455–61.
Dearlove OR, Perkins R. Inadvertent median artery cannulation. Paediatr Anaesth. 2005;15:439–40.
RodrÃguez-Niedenführ M, Sañudo JR, Vázquez T, Nearn L, Logan B, Parkin I. Median artery revisited. J Anat. 1999;195:57–63.
RodrÃguez-Niedenführ M, Vázquez T, Nearn L, Ferreira B, Parkin I, Sañudo JR. Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature. J Anat. 2001;199:547–66.
Diz JC, Ares X, Tarrazo AM, Alvarez J, Meaños ER. Bilateral superficial radial artery at the wrist. Acta Anaesthesiol Scand. 1998;42:1020.
Acknowledgements
We thank Angela Morben, DVM, ELS, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.
Funding
None.
Author information
Authors and Affiliations
Contributions
MM wrote first draft of paper. SH revised drafts and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Written informed consent was obtained from the patient for publication of this case report.
Competing interests
The authors declare that they have no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Matsuo, M., Honma, S. Intra-arterial catheter incidentally placed in the median artery in a patient with an anatomical variation of the radial artery. JA Clin Rep 8, 98 (2022). https://doi.org/10.1186/s40981-022-00588-3
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1186/s40981-022-00588-3
Keywords
- Anatomy
- Arterial catheter
- Medical safety