The impact of two arterial catheters, different in diameter and length, on postcannulation radial artery diameter, blood flow, and occlusion in atherosclerotic patients

Purpose Arterial cannulation is a common intervention in anesthesia practice. However, the success rates and complications of radial arterial cannulation with 20-G or smaller catheters in patients with atherosclerosis have been underevaluated. The aim of this prospective randomized study was to compare the efficacy of and complications with 20- and 22-G catheters for radial arterial cannulation in atherosclerotic patients. Methods Thirty patients with atherosclerosis, American Society of Anesthesiologists (ASA) III–IV, undergoing general anesthesia were enrolled in the study. Radial artery cannulation was performed in group 20G ( n = 15) with a 20-gauge (20 × 1.1 × 33 mm; flow, 61 ml·min −1 ) catheter and in group 22G ( n = 15) with a 22-gauge (22 × 0.9 × 25 mm; flow, 36 ml·min −1 ) catheter. Radial artery systolic blood flow (SBF) and radial artery diameter (RAD) were assessed by a Doppler ultrasound probe before cannulation and 24 h after decannulation for vascular complications. The number of puncture attempts, arterial blood gas samples, and manual flushes; total heparinized solution consumption; duration of cannulation; decannulated radial arterial systolic blood flow; postcannulation RAD; and vascular complications such as occlusion, hematoma, pseudoaneurysm, bleeding, and thrombosis were noted. The Mann Whitney U -test, χ 2 test, and one-sample t -test were used. Values are expressed as medians and quartiles and P < 0.05 was considered as significant. Results The number of puncture attempts was greater in group 20G (range, 1 to 4) than in group 22G (range, 1 to 2; P = 0.02). In group 20G patients, postoperative RAD was larger than preoperative RAD ( P = 0.02) and postoperative SBF was lower than preoperative SBF ( P = 0.03). In group 22G patients postoperative SBF was higher than preoperative SBF ( P = 0.03), while there was no significant difference between preoperative and postoperative RAD. The occlusion rate of atherosclerotic radial arteries was 6% with the 22-gauge catheter and 26% with the 20-gauge catheter ( P = 0.02). Conclusion A 22-gauge catheter for radial arterial cannulation in patients with atherosclerosis provides unchanged postcannulated radial artery diameter, decreases postcannulation complications, and improves the first-attempt success rate.