Radial Artery Pseudoaneurysm

doi:10.1016/j.jhsa.2017.01.024

The Journal of Hand Surgery

Volume 42, Issue 4, April 2017, Pages 295.e1-295.e6

https://doi.org/10.1016/j.jhsa.2017.01.024 Get rights and content

Purpose

To review the causes, clinical course, and management of patients with catheter-associated radial artery pseudoaneurysm (PSA).

Methods

We reviewed all patients diagnosed with radial artery PSA resulting from arterial line placement or radial artery access for cardiac procedures from 2010 to 2015.

Results

We identified 11 cases: 5 caused by arterial lines and 6 by cardiac procedures. The diagnosis was confirmed by duplex ultrasound in all cases; PSA size ranged from less than 1 cm to 5 cm in diameter. Spontaneous thrombosis (over a mean of 27 days) occurred in 4 patients; each PSA was smaller than 3 cm. Surgery was performed in 7 patients with excision of the stalk and repair of the artery as the most common procedure. Only one case was performed emergently for acute carpal tunnel syndrome. Complications occurring owing to either the PSA or the treatment were recorded in 5 patients.

Conclusions

Spontaneous thrombosis may occur in smaller lesions over a few weeks. When required, surgery to evacuate the hematoma and repair the artery was effective in all cases.

Type of study/level of evidence

Therapeutic IV.

Section snippets

Materials and Methods

We performed a retrospective chart review to identify patients diagnosed with radial artery PSA from 2010 to 2015 at 3 urban academic hospitals. We identified 903 patients by Current Procedural Terminology codes associated with cardiac catheterization and radial arterial monitoring and 1,922 patients with International Classification of Diseases, Ninth Revision codes for aneurysm. We cross-referenced both cohorts individually, which yielded 264 patients. This group then underwent a text search

Results

We identified 11 patients with catheter-associated radial artery PSA over the 5-year period. The most commonly affected patients were those in the seventh or eighth decade of life who had a radial artery access procedure for an urgent indication (eg, myocardial infarction, stroke) (Table 1). Arterial line monitoring caused PSA in 5 patients and radial artery access for cardiac catheterization in 6. All patients except one were receiving anticoagulant agents. Duplex ultrasound was used to

Discussion

Radial artery PSA is a rare complication.³ However, as the frequency of radial artery access for procedures increases,4, 5 hand surgeons may increasingly encounter complications. The natural history of PSA in the radial artery is unknown and management principles are largely extrapolated from experience with femoral artery lesions.² Rupture of a femoral artery false aneurysm may have life- and limb-threatening consequences such as shock, stroke, and ischemia.⁶ It is unclear whether the same

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Cited by (27)

Open resection for a large iatrogenic radial artery pseudoaneurysm. Case report
2022, International Journal of Surgery Case Reports
We present the case in which a large symptomatic pseudoaneurysm (PSA), 6 × 5 cm, with one year of evolution on the path of the right radial artery (RRA) appeared after its punction and cannulation for performing cardiac catheterism in an atrial fibrillation (AF) indefinite anticoagulated patient. Diagnosis and surgical planning were consolidated only by using color duplex ultrasound (CDU), contrasted images were not indicated.
The open surgical management was performed during a short-time supraclavicular blockade of peripheral nerves without stopping nor bridging anticoagulant therapy. Complete excision of the deforming mass with no blood loss, decompression of the adjacent structures and direct closure of the arterial defect without compromising of its lumen and path were also achieved.
A 74-year-old, Hispanic male patient and former smoker underwent coronary catheterization for thoracic typical pain. One year after, he is admitted for move restrictive pain in distal right forearm and hand paresthesia related to a rapidly growing right radial artery PSA of 6 cm in diameter where the indefinite anticoagulation, indicated for chronic AF, confers a risk of major bleeding.
After clinic and exclusive CDU assessing, the patient granted us written authorization for performing an open surgery.
One year follow up showed an asymptomatic patient with no RRA residual lesions.
Although contrasted are the preferred diagnosis methods when arterial issues are suspected especially angiography since, when indicated, the endovascular treatment may be performed immediately after diagnosis. The CDU performed with a high-sensitivity transducer is the image of choice for an immediate differential diagnosis (Meola et al., 2021 [1]). In addition, it allowed us to see both, the particular PSA inside structure and the patency of ipsilateral ulnar artery, necessary details to propose the successful open surgical treatment finally conducted.
Vascular and trauma surgeons should be trained to ensure the correct diagnosis based on preexisting medical conditions, clinical findings and those provided by CDU in order to offer an appropriate and definitive management to peripheral vascular iatrogenic lesions with potential bleeding risk, especially in anticoagulated patients. Since large limb deforming PSAs are recommended to be excided through open access, they should also be trained to perform it without additional risks nor sequelae.
Since the number of AF patients is increasing worldwide, main aspects on anticoagulation therapy have to be taught to every surgical team.
Pseudoaneurysm of the Radial Artery After CMC Arthroplasty
2021, Journal of Hand Surgery
Citation Excerpt :
An organized mass develops with the lumen communicating directly with the lumen of the injured vessel. Although catheterization for vascular access is the most common cause of pseudoaneurysm,1,2,4,5 they can also develop as a result of trauma,6 and have been described after fractures7 or operative management of fractures.8 In general, arterial pseudoaneurysms are rare complications.
Pseudoaneurysm of the radial artery is an unusual condition. Most radial artery pseudoaneurysms occur as a result of catheterization; however, any traumatic event that damages the vessel can lead to a symptomatic pseudoaneurysm. This report presents a case of an unusual late presentation of clinical symptoms associated with a pseudoaneurysm of the radial artery after arthroplasty of the thumb carpometacarpal joint.
Successful Treatment of Radial Artery Pseudoaneurysm After Transradial Cardiac Catheterization With Continuous Compression Therapy by a TR Band® Radial Compression Device
2021, Cardiovascular Revascularization Medicine
Citation Excerpt :
Significant implications in the difference between the treatment of radial pseudoaneurysms compared to femoral pseudoaneurysms are the small diameter of the radial artery and the higher risk of complications from thrombin injection and compression therapy [14]. Spontaneous thrombosis of radial artery pseudoaneurysms is possible if small (<3 cm), has a long narrow neck, and low flow volume [15–19]. Continuous compression with a compression bandage or a hemostatic device has been successfully used in patients with systemic anticoagulation and clotting disorders [20–24].
Arterial pseudoaneurysm formation after transradial cardiac catheterization is a rare post-procedural complication occurring in less than 0.1% of radial arterial access. While the data on the management of femoral pseudoaneurysms is extensive, few studies have evaluated how these techniques apply for small vessel arterial pseudoaneurysms. We present the case of an octogenarian man with a radial artery pseudoaneurysm after transradial coronary intervention that failed initial compression therapy, and surgical intervention was avoided by applying continuous compression therapy with a TR Band® radial compression device.
Occasional finding of a radial pseudoaneurysm during radial artery catheterization
2021, Visual Journal of Emergency Medicine
Citation Excerpt :
The main advantages are related to a reduced risk of complications, mainly hemorrhage and vessel damage.1,2 Radial artery pseudoaneurysms (RAP) represent a rare complication, occurring in less than 0.1%.2,3 Even if rare, unrecognized RAP could represent a complex situation when patients require ICU admission and radial artery catheterization for hemodynamic monitoring and blood sampling.
Complications of Transradial Catheterization and Cannulation
2019, Journal of Hand Surgery
Citation Excerpt :
When nonsurgical interventions for pseudoaneurysms fail, surgical treatment is an option. Tosti et al21 reported on the treatment of catheter-related radial pseudoaneurysms in 11 patients. Four patients had not responded to compression therapy, and nonsurgical interventions were not attempted in 7 patients.
Transradial catheterization and cannulation are typically well-tolerated procedures, but they are associated with various vascular, infectious, and orthopedic complications. Potential complications include radial artery occlusion, hematoma formation, radial artery laceration, pseudoaneurysm, abscess formation, and compartment syndrome. Hand surgeons are commonly consulted to treat such complications. We review recent evidence available to guide decisions about nonsurgical and surgical interventions to treat and prevent the complications associated with transradial access procedures.
Management of traumatic and iatrogenic arterial pseudoaneurysms in a tropical environment
2017, JMV-Journal de Medecine Vasculaire
Un faux anévrysme artériel (FAA) est la formation d’un hématome pulsatile et encapsulé, en communication avec la lumière d’une artère perforée. Son origine est diverse mais la majorité des cas est associée à un événement traumatique. Le traitement actuel de référence est la chirurgie endovasculaire mais qui est non faisable pour la majorité des chirurgiens en milieu tropical. Le but de cette étude était de décrire les aspects diagnostiques et thérapeutiques des FAA opérés dans notre institution et d’évaluer la place de la chirurgie conventionnelle dans leur prise en charge thérapeutique. Il s’agit d’une étude rétrospective et descriptive de 30 mois, réalisée dans notre établissement (CHU–JRA, Tananarive, Madagascar) entre 2012 et 2014. Au total, dix cas de FAA étaient opérés. Il existait 8 hommes avec un âge moyen de 30 ans. Les étiologies étaient d’ordre traumatique accidentel (n = 6) ou iatrogène (n = 4). La plupart des patients présentaient une tuméfaction douloureuse et pulsatile (n = 8). L’existence d’une plaie cicatricielle en regard de la tuméfaction était constatée chez 5 patients. Les lésions intéressaient l’artère radiale (n = 3), fémorale (n = 2), brachiale (n = 2), carotide (n = 2) et ulnaire (n = 1). Le diagnostic était confirmé à l’aide d’un échodoppler chez tous les patients. Le traitement était chirurgical et consistait en une suture latérale (n = 4), résection avec anastomose soit terminoterminale directe (n = 1), soit avec l’interposition d’un greffon veineux inversé de la grande veine saphène (n = 2) ou une simple ligature (n = 3). Les suites opératoires étaient simples et le taux de perméabilité primaire était optimal.
A false aneurysm or pseudoaneurysm (PA) is the formation of a pulsatile and encapsulated hematoma in communication with the lumen of a perforated artery. Its origin is different but most cases are associated with a traumatic event. Currently, the referenced treatment is endovascular surgery but it is not feasible for the majority of vascular surgeons working in a tropical environment. The aim of this study was to describe the diagnostic and therapeutic aspects of arterial PA (APA) encountered in our institution and to evaluate the place of open surgical technique in their management. This was a 30-month retrospective and descriptive study carried out in our institution (CHU-JRA, Antananarivo, Madagascar). Between 2012 and 2014, ten cases of APA were operated. There were 8 men with an average age of 30 years. The etiologies were accidental trauma (n = 6) or iatrogenic vascular injury (n = 4). Most patients had a painful and pulsatile swelling (n = 8). The presence of a wound scar located on the swelling was observed in 5 patients. The false aneurysms were localized in the radial (n = 3), femoral (n = 2), brachial (n = 2), carotid (n = 2) and ulnar (n = 1) arteries. The diagnosis was confirmed by ultrasound Doppler in all patients. The treatment was an open surgical procedure and consisted of lateral suture (n = 4), resection with direct end-to-end anastomosis (n = 1) or using autologous saphenous vein graft (n = 2) or ligation (n = 3). Postoperative courses and outcomes at last follow-up were uneventful with optimal patency rate.

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Scientific articleRadial Artery Pseudoaneurysm

Purpose

Methods

Results

Conclusions

Type of study/level of evidence

Section snippets

Materials and Methods

Results

Discussion

Ann Vasc Surg

J Vasc Surg

Am Heart J

JACC Cardiovasc Interv

Ann Vasc Surg

J Am Coll Cardiol

J Hand Surg Am

J Vasc Surg

Unusual vascular complications associated with transradial coronary procedures among 10,324 patients: case based experience and treatment options

J Interv Cardiol

Risk of rupture of post angiographic femoral false aneurysm

Br J Surg

Scientific article
Radial Artery Pseudoaneurysm