SNUH Researchers Discover Method to Prevent Blood Vessel Blockage After Surgery in Infants > GENERAL HOSPITAL

"Is there a way to prevent blocked blood vessels after surgery?"

Seoul National University Hospital (SNUH) researchers have found the answer.

A research team led by Professor Jang Young-eun (Department of Anesthesiology and Pain Medicine) has, for the first time in the world, prevented radial artery occlusion, a common complication after surgery in infants, using 'subcutaneous injection of the vasodilator nitroglycerin'.

A small but significant change in a single blood vessel is leading to a safer future for children. ✨

SNUH Identifies World's First Method for Preventing Radial Artery Occlusion After Surgery in Infants

- Radial artery occlusion rate decreased after subcutaneous nitroglycerin injection: 73.8% vs. 25.4%

- No major side effects reported... Suggesting the possibility of safe and effective surgery for infants

[Data] Radial Artery Occlusion Test Method for Infants

The radial artery in the wrist is a blood vessel where an arterial catheter is often inserted to monitor blood pressure during surgery. However, more than 60% of infant patients experience radial artery occlusion, where blood flow in this vessel is blocked after surgery. Recently, a research team at Seoul National University Hospital identified for the first time in the world that the vasodilator 'nitroglycerin' can significantly reduce the incidence of radial artery occlusion in infants. The results of this study, published in the prestigious pediatric journal 'JAMA Pediatrics (IF; 18.0)', are expected to become a new standard for improving the safety of pediatric anesthesia and intensive care.

Infants under the age of 3 have thin blood vessels and frequent vasospasms, making arterial catheter insertion and maintenance very difficult. Using vasodilators such as nitroglycerin can increase the success rate of arterial catheter insertion, but 'radial artery occlusion' occurs in 3 out of 5 patients after the arterial catheter is removed. This is a serious complication that can lead to peripheral ischemia and skin necrosis, and the risk is especially high for children who have had an arterial catheter inserted for a long period of time while undergoing surgery and intensive care. However, there has been no clear method for preventing radial artery occlusion until now.

The research team, led by Professors Jang Young-eun and Park Jung-bin of the Department of Anesthesiology and Pain Medicine at Seoul National University Hospital, announced on the 27th the results of a randomized clinical trial comparing the preventive effect of subcutaneous nitroglycerin injection on radial artery occlusion in 132 patients under the age of 3 who underwent surgery under general anesthesia from 2022 to 2025.

72.7% of the study subjects were high-risk patients with moderate to severe systemic diseases (ASA-PS grade 3 or higher*), and most underwent cardiac, neurosurgical, or surgical procedures due to congenital diseases. They were randomly assigned to the treatment group (67 patients) and the control group (65 patients), and received 0.5mL of diluted nitroglycerin or saline solution subcutaneously above the radial artery once before and after arterial catheter insertion.

*ASA-PS (American Society of Anesthesiologists Physical Status Classification) Grade 3 or higher refers to patients with moderate to severe systemic diseases (heart failure, obstructive pulmonary disease, hemodynamic instability, etc.) who are at high risk of complications during surgery.

Afterward, the research team compared and analyzed the incidence of radial artery occlusion, blood flow status, and side effects in the treatment and control groups.

[Data] Key Research Results. The incidence of radial artery occlusion in the nitroglycerin treatment group was 25.4%, which is significantly lower than that of the control group (73.8%).

As a result, the incidence of radial artery occlusion in the treatment group was 25.4%, a reduction to one-third of that in the control group (73.8%). No major side effects (hypotension, local bleeding, etc.) of the vasodilator were reported in the treatment group, proving that nitroglycerin safely and effectively prevents radial artery occlusion in pediatric patients.

In addition, after arterial catheter removal, the radial artery blood flow velocity in the treatment group was on average 1.8 times faster and the perfusion index (degree of blood circulation in peripheral blood vessels) was on average 2.1 times higher than in the control group. This result means that nitroglycerin helps maintain normal blood flow even after arterial catheter removal and can contribute to preserving blood vessels in pediatric patients.

On the other hand, it was found that even if radial artery occlusion occurred after arterial catheter removal, rapid blood flow recovery was possible when nitroglycerin was used. In the treatment group, 14 out of 17 patients (82.4%) who developed occlusion recovered blood flow before discharge, while only 20 out of 48 patients (41.7%) in the control group recovered.

Professor Jang Young-eun (corresponding author) said, "It is meaningful to have proven for the first time in the world a method to prevent radial artery occlusion, which commonly occurs after pediatric surgery. I hope that children with complex congenital diseases such as heart and brain who undergo multiple high-risk surgeries and intensive care can reduce the risk of blood vessel damage and receive treatment in a safer environment based on these results."

This research was supported by the National Research Foundation of Korea (RS-2022-NR074241).

[Photo from left] Professors Jang Young-eun and Park Jung-bin, Department of Anesthesiology and Pain Medicine

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Source :https://blog.naver.com/chsnuh/224058988492

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