A 78-year-old male patient with COVID-19 was admitted to the emergency room for hemorrhagic shock related to a ruptured middle-colic artery aneurysm. In the days before admission, he was treated for a COVID-19 infection with monoclonal antibodies. In the emergency room, he appeared in a very serious clinical condition, was intubated and treated with inotropic drugs. Embolization of the middle colic artery was performed to stop active bleeding, and cannulation of the left radial artery was performed.
At admission to the medical ward, a pseudoaneurysm of the radial artery (Figure 1A) was detected with a portable ultrasound device (Butterfly IQ+). In the following days, the size of the pseudoaneurysm increased (Figure 1B).
The pseudo-aneurysmal formation was later confirmed by computed tomography (CT) (Figure 1C). CT showed a diameter of about 8 mm at the level of the distal third of the radial artery, corresponding to the distal radial epiphysis. The following day a sudden rupture of the pseudoaneurysm was observed. Selective arteriography of the radial artery confirmed the pseudoaneurysm of the distal third of the artery with active spread of contrast medium. The pseudoaneurysm was embolized with a microcatheter. No blood flow was detected after embolization with a portable ultrasound device (Figure 1D). The patient was discharged in good clinical condition.
Pseudoaneurysm of the artery represents a rare complication (incidence of 0.048% [1]) that can occur after attempts to canalize the radial arteries [2]. We cannot exclude that COVID-19 increased the risk of fragility of the arterial wall. Inflammation of the arteries and increased oxidative stress could play a pivotal role in increasing vascular complications in COVID-19 patients [3, 4]. Some studies reported rupture of aneurysms or dissections aggravated by COVID-19 [5].
Portable ultrasound reliably diagnoses radial artery pseudoaneurysms and is a valuable tool for early detection of vascular diseases.
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