When one complication begets another – A case report of radial artery pseudoaneurysm following radial artery occlusion post-transradial coronary angiography

Abstract

The transradial approach for coronary angiography and intervention is the preferred approach because of its superior safety profile as compared to the transfemoral approach. However, like all procedures, transradial approach is not free from complications. In this case, we describe a unique case of a large symptomatic radial artery pseudoaneurysm requiring urgent surgical intervention. The pseudoaneurysm developed after treatment with a short duration of subcutaneous low molecular weight heparin for radial artery occlusion that occurred a day after transradial coronary catheterization. The pseudoaneurysm was repaired successfully and there was no recurrence during subsequent follow-up. Access-related complications post transradial approach are generally uncommon and this is the first reported case of radial artery occlusion further complicated by a large pseudoaneurysm to the best of our knowledge. Preventive measures are crucial in reducing radial artery occlusion while we recommend an individualized approach based on clinical history coupled with anatomic features of pseudoaneurysm in managing radial artery pseudoaneurysm. hLearning objective: Access-related complications post transradial approach coronary angiography, while rare, can still occur. Preventive measures as well as close monitoring post angiography are crucial in the prevention as well as early detection of access-related complications. Management of radial artery pseudoaneurysm should be individualized based on clinical context as well as anatomic characteristics of the pseudoaneurysm.i

Late massive radial artery pseudoaneurysm following cardiac catheterization: A case report

“…As in the case described, radial artery pseudoaneurysms are relatively rare, occurring in less than 0.1% of cases [ 2 , 8 ]. Pseudoaneurysms occur with defective healing of the catheterization puncture site.…”

“…Pseudoaneurysms occur with defective healing of the catheterization puncture site. Failure in healing of the vessel allows for a continuous loss of arterial blood and further development of a hematoma with connecting neck and turbulent blood flow [ 4 , 8 ]. The presentation may consist of a palpable, pulsatile mass, progressive enlargement, pain, and an audible bruit [ 2 ].…”

Radial artery pseudoaneurysm a rare complication after coronary angiography: A case report and systematic review of the reported cases

“…The literature included 41 patients from 32 case reports (Figure 2 and Table 1). 6,8–38 The mean age of patients was 68.5 years with a male prevalence of 49%. Onset of pseudoaneurysm ranged from 0 days (directly after the catheterization) to 150 days with a median of 5 days.…”

Rare case of radial artery pseudoaneurysm protruding through skin after a single arterial puncture for blood-gas analysis

“…Regarding the management of radial artery pseudoaneurysm, there have been proposed many therapeutic options which vary according to the size, location or any other anatomic feature of the lesion, the etiology, the blood flow status proximally and distally to the lesion and the presence of any other associated symptoms [11]. Nonsurgical treatment, that requires thrombus formation, includes clinical observation, mechanical compression with bandages, ultrasoundguided compression repair, ultrasound-guided percutaneous thrombin injection or endovascular therapy [5,[11][12].…”

“…Generally, in cases of lesions, relative small in size (<1 cm) which have been detected early, conservative treatment can offer a reliable outcome as the majority of them will be thrombosed within 3-4 weeks [5,[11][12]. On the contrary, surgical intervention is needed in cases of large lesions (>2-3 cm), in complicated cases or when nonsurgical treatment fails.…”