Radial artery aneurysm in the anatomical snuff box: A case report and literature review

Ultrasound-guided distal transradial access for cardiac catheterization: Technical notes for the interventionalist

Over the latest years, the use of distal radial access (dTRA), also called "snuffbox," has become more and more popular for cardiac catheterization. Indeed, dTRA has several advantages compared to the traditional proximal radial approach, such as a lower risk of hand ischemia, radial artery occlusion (RAO) and faster post-procedural hemostasis. However, due to the presence of different muscular-skeletal structures, as well as to the small diameter of the distal radial artery (dRA), an ultrasound-guided cannulation would be preferred since a blind puncture increases the risk of tendon damage and/or the irritation of the underlying periosteum. The present article is aimed to provide the key tips for performing US-guided access using the dRA in patients undergoing percutaneous cardiac procedures.

Snuff box radial artery aneurysm: A case report and literature review

INTRODUCTION AND IMPORTANCE

Distal radial artery aneurysms in the anatomical snuff box are rare.

CASE PRESENTATION

Herein, we present the case of a snuff box radial artery aneurysm in a female patient with a possible history of trauma and discuss the evaluation and management of snuff box radial artery aneurysms. The aneurysm in this case was resected without reconstruction because of a normal preoperative Allen test finding and intraoperative evidence of adequate hand perfusion after the aneurysm was excised. The patient subsequently recovered with proper hand function.

CLINICAL DISCUSSION

Radial artery aneurysms cases are rare; literature search by us and others have identified only 20 cases. For the detection and management of aneurysm, several high-end techniques may be employed; however, in this case, we employed non-invasive ultrasound method. The method is non-invasive and accurately delineates and localises an aneurysm, differentiates true arterial aneurysms from pseudoaneurysms, and identifies the presence of a mural thrombus. Further, the ultrasound assessments also help surgeons on requirement of radial artery reconstruction.

CONCLUSION

In this case report, an anatomical snuff box radial artery aneurysm was surgically excised without reconstruction. Physical examination and Doppler ultrasound findings were employed to assess the medical condition of the patient; patient's proper hand function was restored.

Radial Artery Pseudoaneurysm Following Cardiac Catheterization: A Case Report

The transradial approach is the most preferred method for cardiac catheterization. The radial route approach has many advantages, including fewer puncture site-related complications and early mobility and discharge. The vascular complications include radial artery spasms, occlusions, dissections, perforations, and compartment syndrome. Although pseudoaneurysms are a well-known complication of femoral access (0.2%-3%), pseudoaneurysms are very infrequent (0.05%) after radial artery access. Very few cases of radial pseudoaneurysms have been reported to date. We present a rare case of an 82-year-old man on dual antiplatelet and anticoagulant therapy who underwent coronary angiography via the radial route. The patient developed a pseudoaneurysm requiring surgical intervention.

True radial artery aneurysm in a patient with somatic mosaicism for a mutation in platelet-derived growth factor receptor β gene

We have presented the case of a right radial artery aneurysm (RAA) in a 27-year-old man with cerebral and coronary artery aneurysms and features of Parkes-Weber syndrome (port-wine stains and right upper extremity arteriovenous malformation and overgrowth). The RAA was repaired with an interposition great saphenous vein bypass graft. Analysis of the intracranial artery aneurysm and affected skin demonstrated a somatic mutation in the platelet-derived growth factor receptor-β gene. Mosaicism was present in the RAA but not in the great saphenous vein. Somatic mosaicism should be considered as a possible etiology for peripheral aneurysms in patients for whom standard genetic test results are unrevealing.

Mycotic aneurysm of the distal radial artery after cardiac catheterisation

A mycotic aneurysm of the distal radial artery following access for cardiac catheterisation is a rare complication that has not been described in the literature. We present the case of an 84-year-old man who developed bacteraemia and cellulitis over his left first dorsal webspace 2 days after undergoing cardiac catheterisation through the distal radial artery at the anatomic snuffbox. Ultrasound scanning and CT imaging were concerning for a possible pseudoaneurysm at that location. Once we confirmed that the patient had adequate flow through his hand with angiography and an Allen's test, we explored his left hand and found a mycotic aneurysm of the distal radial artery with surrounding frank purulence. We resected the aneurysm and ligated the artery. Pathology confirmed that this was a mycotic aneurysm. The patient quickly recovered from his infection after this definitive treatment.

Atraumatic Left Distal Radial Artery Aneurysm

Distal radial artery aneurysms are an uncommon pathological entity in the field of surgery. Moreover, distal radial artery aneurysms of idiopathic etiology are even rarer. Herein, we present a rare case of idiopathic/atraumatic left radial artery aneurysm. A 73-year-old female patient presented with a chief complaint of a pulsatile mass located on her left wrist. Radiological imaging showed the presence of a distal radial artery aneurysm which was successfully surgically excised with subsequent ligation of the radial artery. Some of the etiologies and operative management of distal radial artery aneurysm in the anatomical snuffbox to what is in accordance with the literature are discussed. Distal radial artery aneurysms are rare. Hence, their misdiagnosis may lead to wrongful management and increase in morbidity. The appropriate management of distal radial aneurysm is almost always surgical.

Digital Artery Aneurysm: A Case Report

Digital artery aneurysms of the hand are atypical. We herein present a rare case of digital artery aneurysm. A 60-year-old man presented with a complaint of a mass on the back of his left hand. A radiological examination indicated a digital artery aneurysm. The patient underwent successful surgical excision of an aneurysm of the left dorsal digital artery on the ulnar face of the third finger of the left hand. We discuss the etiology and surgical management of digital artery aneurysms according to literature data. An accurate diagnosis and a preoperative blood flow assessment are required for appropriate surgical management of digital artery aneurysms.

Management of Unusual Proximal Radial Artery Aneurysm

Distal upper extremity arterial aneurysms are rare with only a few case reports and small retrospective studies described. Most aneurysms are secondary to trauma making idiopathic aneurysms an especially rare disease process. An 83-year-old male presented with a painful pulsatile mass that was confirmed with ultrasound and computed tomography angiogram as a 2.0 × 1.5 cm radial artery aneurysm. He had successful aneurysm resection and primary repair. Histopathology confirmed a true aneurysm. This case report demonstrates successful excision and repair of this rare pathology. This case is been reported more for its rarity than complexity of the treatment.

Repair of a symptomatic true radial artery aneurysm at the anatomic snuff box with interposition great saphenous vein graft

Radial artery aneurysms are exceedingly rare, with only a few reported cases of surgical revascularization. We describe a 25-year-old man who presented with severe ischemia of the right hand secondary to an idiopathic true radial artery aneurysm at the anatomic snuff box. The patient had embolic occlusions in his hand and fingers that were treated with catheter-directed thrombolysis. During angiography, the blood supply to the affected hand was determined to be radial artery dominant, and therefore the aneurysm was resected and revascularized using an interposition great saphenous vein graft. The patient denied ischemic symptoms postoperatively, and duplex ultrasound examination at a 10-month follow-up showed patent interposition graft.