Persistent median artery accidentally identified during radial artery catheterization: A case report

Radial artery catheterization is commonly performed using the pulse palpation method. However, anatomical variations, such as the persistent median artery—an embryonic structure that may persist into adulthood—can complicate this procedure. A 47-year-old female scheduled for laparoscopic surgery required radial artery catheterization for hemodynamic monitoring. Multiple attempts to place a 22-gauge catheter in the left radial artery were unsuccessful. During the procedure, a pulsating vessel was identified on the ulnar side of the radial artery. Vascular visualization devices revealed the presence of a persistent median artery, accompanied by the median nerve. Subsequently, real-time ultrasound guidance facilitated successful radial artery catheterization. Anatomical variations, such as the persistent median artery, can complicate radial artery catheterization and are not easily identified through pulse palpation alone. The use of vascular visualization devices is recommended to identify and navigate such variations, ensuring accurate catheter placement.