Seoul National University Hospital Identifies World's First Method to Prevent Radial Artery Occlusion After Surgery in Infants and Young Children

Incidence of Radial Artery Occlusion Decreases After Subcutaneous Nitroglycerin Injection

The research team led by Professors Young Eun Jang and Jung Bin Park from the Department of Anesthesiology and Pain Medicine at Seoul National University Hospital announced on October 27 the results of a randomized clinical trial comparing the preventive effects of subcutaneous nitroglycerin injections on radial artery occlusion in 132 patients under the age of three who underwent surgery under general anesthesia from 2022 to 2025. This study is the world’s first to demonstrate that the use of the vasodilator nitroglycerin can significantly reduce the incidence of radial artery occlusion in infants and young children. Published in the prestigious pediatric journal JAMA Pediatrics (IF: 18.0), these findings are expected to set a new standard for enhancing the safety of pediatric anesthesia and critical care.

(From left) Professors Young Eun Jang and Jung Bin Park, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital. Seoul National University Hospital

The radial artery in the wrist is the primary vessel used for arterial catheter insertion to monitor blood pressure during surgery. However, more than 60% of infant patients experience radial artery occlusion, or blockage of blood flow in this artery, after surgery. Children under the age of three have narrower blood vessels and are prone to frequent vasospasms, making arterial catheter insertion and maintenance extremely challenging. While vasodilators such as nitroglycerin can increase the success rate of arterial catheter insertion, three out of five patients still develop radial artery occlusion after the 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 arterial catheters inserted for extended periods during surgery or intensive care. Until now, however, there has been no proven method to prevent radial artery occlusion.

In this study, 72.7% of participants were classified as high-risk, with moderate to severe systemic disease (ASA-PS grade 3 or higher), and most underwent cardiac, neurosurgical, or general surgical procedures due to congenital disorders. The patients were randomly assigned to a treatment group (67 patients) or a control group (65 patients). Each group received a subcutaneous injection of either diluted nitroglycerin or saline (0.5 mL) above the radial artery once before arterial catheter insertion and once at the time of removal.

The research team then compared the incidence of radial artery occlusion, blood flow status, and adverse events between the treatment and control groups. The results showed that the incidence of radial artery occlusion in the treatment group was 25.4%, which is about one-third of the rate in the control group (73.8%). No major side effects of the vasodilator, such as hypotension or local bleeding, were reported in the treatment group, proving that nitroglycerin can safely and effectively prevent radial artery occlusion in pediatric patients.

Furthermore, after arterial catheter removal, the treatment group had an average radial artery blood flow velocity 1.8 times faster and a perfusion index 2.1 times higher than the control group. These results indicate that nitroglycerin helps maintain normal blood flow even after catheter removal and contributes to preserving vascular health in pediatric patients.

Professor Jang stated, "It is meaningful to be the first in the world to demonstrate a method to prevent the commonly occurring radial artery occlusion after pediatric surgery," adding, "We hope that children who undergo multiple high-risk surgeries and intensive care treatments due to complex congenital disorders affecting the heart and brain can use these findings to reduce the risk of vascular injury and receive treatment in a safer environment."

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

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