English Polski
Vol 23, No 4 (2017)
Case report
Published online: 2017-12-28

open access

Page views 1295
Article views/downloads 1964
Get Citation

Connect on Social Media

Connect on Social Media

Radial artery pseudoaneurysm (RAP) following transradial intervention — an extremely rare complication successfully managed by surgery: case report

Santosh Kumar Sinha, Mukesh Jitendra Jha, Vikas Mishra, Mahmadula Razi, Anupam Mahrotra, Mohammad Asif, Nasar Abdali, Vikas Chaturvedi, Lokendra Rekwal
Acta Angiologica 2017;23(4):165-169.

Abstract

The transradial access for diagnostic and therapeutic purpose is becoming increasingly popular, mainly because of its lack of complications. Radial artery pseudoaneurysm (RAP) is an extremely rare complication, so many of its clinical features are unknown and treatment is not systematic. Therapeutic options are conservative management, ultrasound-guided compression, thrombin injection and surgical intervention. Here, we report a 43-year old female who underwent transradial percutaneous angioplasty of left anterior descending artery. During cannulation of her radial artery, multiple puncture attempts were done. Upon removal of the transra¬dial compression band (TR Band), forearm ecchymosis and small hematoma were noted with mild pain. Tight compression bandage was applied but on the following day, she had complaints of increasing right forearm pain and tenderness. Physical evaluation revealed increased swelling of the right forearm and an ultrasound of the right forearm demonstrated a RAP of the right radial artery measuring up to 3.9x1.9 cm with 3.4 mm neck. Tight compression bandage was further prolonged following ultrasound compression with vascular probe which failed to alleviate her complaints. Following failure of conservative therapy and in lieu of her symptoms, surgical exploration, clot removal and successful repair was done.

References

  1. Rodríguez-Olivares R, García-Touchard A, Fernández-Díaz J, et al. Abordaje transulnar con arteria radial homolateral ocluida: descripción de la vascularización del antebrazo y seguimiento a largo plazo. Revista Española de Cardiología. 2014; 67(10): 854–855.
  2. Sanmartín M, Cuevas D, Goicolea J, et al. Complicaciones vasculares asociadas al acceso transradial para el cateterismo cardíaco. Revista Española de Cardiología. 2004; 57(6): 581–584.
  3. Kerr CD, Duffey TP. Traumatic false aneurysm of the radial artery. J Trauma. 1988; 28(11): 1603–1604.
  4. Komorowska-Timek E, Teruya TH, Abou-Zamzam AM, et al. Treatment of radial and ulnar artery pseudoaneurysms using percutaneous thrombin injection. J Hand Surg Am. 2004; 29(5): 936–942.
  5. Swanson E, Freiberg A, Salter DR. Radial artery infections and aneurysms after catheterization. J Hand Surg Am. 1990; 15(1): 166–171.
  6. Ganchi PA, Wilhelmi BJ, Fujita K, et al. Ruptured pseudoaneurysm complicating an infected radial artery catheter: case report and review of the literature. Ann Plast Surg. 2001; 46(6): 647–650.
  7. Isabel Zegrı´, Arturo Garcı´a-Touchard, Sofı´a Cuenca, Juan Francisco Oteo, Jose´ Antonio Ferna´ndez-Dı´az, and Javier Goicolea. Radial Artery Pseudoaneurysm Following Cardiac Catheterization: Clinical Features and Nonsurgical Treatment Results. Scientific letters / Rev Esp Cardiol. 2015; 68(4): 343–354.
  8. Kiemeneij F, Laarman GJ, Odekerken D, et al. A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the access study. J Am Coll Cardiol. 1997; 29(6): 1269–1275.
  9. Kanei Y, Kwan T, Nakra NC, et al. Transradial cardiac catheterization: a review of access site complications. Catheter Cardiovasc Interv. 2011; 78(6): 840–846.
  10. Collins N, Wainstein R, Ward M, et al. Pseudoaneurysm after transradial cardiac catheterization: case series and review of the literature. Catheter Cardiovasc Interv. 2012; 80(2): 283–287.
  11. Liou M, Tung F, Kanei Y, et al. Treatment of radial artery pseudoaneurysm using a novel compression device. J Invasive Cardiol. 2010; 22(6): 293–295.
  12. Hamid T, Harper L, McDonald J. Radial artery pseudoaneurysm following coronary angiography in two octogenarians. Exp Clin Cardiol. 2012; 17(4): 260–262.