Surgical Repair of a Radial Artery Aneurysm Following Elective Percutaneous Coronary Intervention: A Case Report

Abstract

Background: Transradial approach for percutaneous coronary intervention (PCI) is frequently preferred because it has lower complication rates than femoral access. However, unusual vascular complications, such as radial artery pseudoaneurysms, might arise, requiring diagnostic and treatment challenges.

Case Summary: We present a case of a 68-year-old man who underwent an elective right radial percutaneous coronary intervention (PCI) with a 6 Fr sheath. Following the procedure, he experienced the development of a non-painful, progressively growing pulsatile mass at the site of access ten days later. A duplex ultrasound revealed a saccular pseudoaneurysm measuring 22 × 18 mm, characterized by a 2.5 mm neck and to-and-fro flow patterns. A CT angiography confirmed the presence of a localized pseudoaneurysm without any signs of distal embolization. After a discussion among specialists, Surgical intervention was decided, while maintaining the patency of the radial artery and avoiding any distal ischemia. The patient was discharged the next day and remained asymptomatic with duplex-confirmed thrombosis after 1 and 6 months.

Conclusion: A delayed pulsatile swelling following transradial procedures should lead to the use of duplex imaging. For anatomically appropriate radial pseudoaneurysms, ultrasound-guided thrombin injection is an efficient and minimally invasive treatment option for small sized pseudoaneurysms. For large, symptotic pseudoaneurysm, Surgical removal is the treatment of choice.