Successful coil embolization with distal radial access for a ruptured radial artery pseudoaneurysm in a patient with SARS‐CoV‐2 infection

Abstract

A 50‐year‐old man with a medical history of diabetes mellitus and hypertension was admitted to a university hospital for severe respiratory insufficiency caused by SARS‐CoV‐2 infection. His arterial blood pressure and blood oxygen levels were monitored through a plastic cannula inserted in the radial artery in the intensive care unit. After recovery from respiratory insufficiency, the patient was moved to a local hospital where hematoma formation and skin necrosis at the puncture site were noted. On the 25th day from the initial admission, the patient developed massive bleeding from the wound on the hematoma and was transferred to our hospital on emergency. A 6‐Fr sheath introducer was inserted through the right distal radial artery in the anatomical snuff box, and instant hemostasis was accomplished without external compression. Thereafter, percutaneous thrombin injection for the pseudoaneurysm was conducted under ultrasound guidance. However, bleeding from the pseudoaneurysm was still observed after radial sheath withdrawal. We then performed coil embolization of the radial artery, which involved a coil proximal to the aneurysm, four coils in the neck of the aneurysm, and two coils distal to the aneurysm. Permanent hemostasis was achieved with no further vascular complications.

Endovascular Management of Thenar-Hypothenar Aneurysms: Two Case Reports and Review of Literature

“…However, this is possible only if the artery has a straight course; also, it may be technically challenging, with a risk of stent thrombosis. Regarding coil embolization, various case reports have been presented in diverse clinical situations [ 7 , 10 - 12 ]. Complete coil embolization of aneurysms, with the sacrifice of distal radial or ulnar arteries, has been reported when the remaining single vessel runoff and the palmar arch to the fingers are patent [ 10 , 11 ].…”

“…Regarding coil embolization, various case reports have been presented in diverse clinical situations [ 7 , 10 - 12 ]. Complete coil embolization of aneurysms, with the sacrifice of distal radial or ulnar arteries, has been reported when the remaining single vessel runoff and the palmar arch to the fingers are patent [ 10 , 11 ]. Additionally, coil embolization has been successfully employed for thenar/hypothenar aneurysms in cases with a patent palmar arch [ 7 , 12 ].…”