Median nerve palsy: a complication of brachial artery cardiac catheterization

Area of Science:

• Vascular Surgery
• Neurology
• Cardiology

Background:

• Cardiac catheterization is a common procedure for diagnosing and treating cardiac conditions.
• Complications, though rare, can arise from arterial access, impacting surrounding neurovascular structures.
• Ischemic cardiac disease patients may have unique risk factors during invasive procedures.

Observation:

• A patient developed complete median nerve palsy six hours post-left brachial artery cardiac catheterization.
• The palsy was attributed to a hematoma compressing the median nerve, located proximally to the arterial puncture site.
• Catheter perforation of the brachial artery wall was suspected as the cause of the hematoma.

Findings:

• Surgical exploration revealed a brachial artery hematoma compressing the median nerve.
• The hematoma was successfully removed, and the median nerve was decompressed.
• Median nerve function fully recovered one year after surgical intervention.

Implications:

• This case highlights a rare but significant neurological complication of brachial artery catheterization.
• Early recognition and surgical management are crucial for favorable outcomes in iatrogenic median nerve injury.
• Understanding potential arterial wall injury mechanisms is vital for procedural safety in cardiac catheterization.