Radial artery pseudoaneurysms treated by ultrasound-guided differential compression: An effective and simple method

Abstract

Transradial approach has become preferable to conventional femoral artery access for both diagnostic coronary angiography and percutaneous coronary intervention. A rare but recognizable complication of radial access is radial artery pseudoaneurysm (RAp), which represents a potentially catastrophic complication. Treatment options comprise ultrasound (USG)-guided manual compression or thrombin injection or surgical correction. In this case series, we report four cases of RAps that we encountered at a single tertiary care center from July 2015 to January 2018. We compressed the radial artery using a sphygmomanometer cuff differentially rather than a TR band proximal to the pseudoaneurysm to treat three of them. One of the patients underwent surgical repair of the pseudoaneurysm as the location of the aneurysm was not suitable for compression or thrombin injection. In our series of cases, we conclude that RAp, a rare complication of radial catheterization, was seen more commonly in elderly female patients and can be easily treated by the USG-guided differential compression, a simple and readily available method. Prevention and early diagnosis is the key to avoid serious consequences.

A case report of surgical repair of a post-catheterization radial pseudoaneurysm

“…Infection, skin ischemia and frail appearance of the PSA are contraindications [ 2 ]. Some authors suggest occluding selectively the proximal radial artery (after identification with ultrasound) for 2-4 hours [ 4 , 7 ].…”

“…In our patient a partial transection of the radial artery from the sheath was presumably the causative process for PSA formation. Prevention of radial pseudoaneurysms include proper and meticulous use of guidewires and catheters, adequate wrist compression and early detection of a local hematoma [ 4 ]. These measures should be more intense in anticoagulated patients.…”

“…Up to date, apart from case reports, only a few large series exist examining the incidence of complications after radial access for coronary angiography [ 1 ]. Additionally, there are no clinical trials regarding the best treatment of PSAs, and consequently no systemic guidelines exist [ 2 - 4 ]. We present a patient with a painful radial pseudoaneurysm, treated urgently with ligation and discuss alternative treatment options, as well as preventive measures.…”

Geçmişten Günümüze Koroner Anjiyografide Transradyal Yaklaşım

“…Pseudoaneurysm and radial artery perforation have been reported as rare complications. Among the risk factors; penetrating injury to the arterial wall during cannulation, multiple punctures to the artery, catheter infection, aggressive anticoagulant therapy, and large sheath sizes used during the procedure can be considered (32). The intervention site complications that may develop after transradial CAG are summarized in Table 2.…”