Lung Cancer Surgery Followed by Severe Arm Ischemia and Amputation

What happened, in summary

A woman in her mid-60s with lung adenocarcinoma underwent a right upper lobectomy. The operation began robotically but was converted to an open thoracotomy. During her postoperative intensive-care stay, several arterial lines were required to monitor her condition.

After a left axillary arterial line had been in place for 6 days, she developed tingling, numbness, and bluish discoloration in her left hand. Imaging showed blockages in the axillary, brachial, and radial arteries. Emergency surgery removed the clots and initially restored blood flow, but the problem returned. A second operation was performed, followed by clot-dissolving treatment and surgery to relieve pressure in the forearm.

Despite these efforts, blood flow to the hand could not be maintained. Tissue from the fingers to the proximal forearm became nonviable, and she ultimately required a transhumeral, or above-elbow, amputation 29 days after the original lung operation. She recovered from the amputation and attended repeated orthopedic follow-up visits. Eleven months later, she underwent surgery for painful neuromas and continued to experience phantom-limb pain.

The case centers on a rare but life-changing vascular complication after lung-cancer surgery. She was adapting to daily activities with one arm, using assistive tools for tasks such as cooking and cleaning.