Radial artery pseudoaneurysm successfully treated by compression bandage

Nontraumatic Pseudoaneurysm of the Deep Palmar Arch in a 10-Month-Old Infant: A Case Report

CASE

Pseudoaneurysms of the hand are rare among the adult population and even more rare in pediatric patients. We report a case of a 10-month-old boy who presented with a nontraumatic pseudoaneurysm of the deep palmar arch, likely of congenital etiology. Magnetic resonance imaging and angiography identified the growing left hand palmar mass. Surgical excision without the need for vascular reconstruction was performed successfully with no recurrence or complications at 1-year follow-up.

CONCLUSION

Surgical excision is an effective treatment for large or symptomatic palmar pseudoaneurysms of likely congenital origin. Vascular reconstruction after excision must be considered on a case-by-case basis to ensure adequate hand perfusion.

Post-Traumatic Radial Artery Pseudoaneurysm at the Wrist Level: A Case Report

A pseudoaneurysm is a collection of blood outside the arterial lumen but remains in continuity with the lumen and lined by fibrous tissue. Radial artery pseudoaneurysm is a rare entity mostly occurring due to iatrogenic reasons. Traumatic causes are rare. In this case report, we report a post-traumatic left radial artery pseudoaneurysm at the wrist level in a 20-year-old male patient. The patient was treated with end-to-end repair of excised pseudoaneurysm with a vein graft taken from the radial artery vena comitantes through the same incision.

Radial Artery Pseudoaneurysm From a Squirrel Bite

Radial artery pseudoaneurysm is a rarelimb-threatening complication that occurs from vascular procedures and direct trauma. We present a rare case of a 74-year-old female who presented to the emergency department with a squirrel bite to her right wrist. Although initially benign-appearing, computed tomography angiography of the right upper extremity showed a pseudoaneurysm at the distal radial artery. The patient was successfully treated with careful compression and rapid resolution was confirmed with an arterial right upper extremity ultrasound that visualized a formed thrombus. Emergency providers should have a high index of suspicion for radial artery pseudoaneurysms in the setting of animal bites to the wrist.

Management of traumatic superficial palmar arch pseudoaneurysm: a therapeutic challenge

Pseudoaneurysm of the palmar arch is a rare entity. Diagnosis is dependent on high clinical suspicion. We present a case referred to the emergency department, with a history of glass penetrating trauma to the palmar surface with a pulsatile mass and jet bleeding. Doppler ultrasound evidenced a partially thrombosed pseudoaneurysm. A CT angiography examination showed a saccular formation arising from the superficial palmar arch. A conventional surgical approach was indicated. A clinical suspicion must be ventured to arrive at the correct diagnosis. Imaging modalities are needed to identify the pseudoaneurysm and plan the treatment course. Nonetheless, the sequence of diagnosis is individual, because further evaluation with different imaging methods may not change the rationale for the intervention. In our experience, conventional surgical removal is preferable, due to its safety and well-established outcomes.

Radial artery pseudoaneurysm following wrist trauma. A case report of a rare condition

In the presence of limb trauma, the appearance of local edema should always be carefully examined by Orthopaedics surgeons. A post-traumatic wrist swelling without fracture could even lead to serious pathologies and relative sequelaes. These include the radial artery pseudoaneurysm. In this report we present a case of radial artery pseudoaneurysm following wrist trauma, successfully treated whit conservative treatment.

Successful Treatment of Radial Artery Pseudoaneurysm After Transradial Cardiac Catheterization With Continuous Compression Therapy by a TR Band® Radial Compression Device

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.

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

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. 〈Learning 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.〉.

Radial Artery Pseudoaneurysm following Cardiac Catheterization: A Nonsurgical Conservative Management Approach

A radial artery pseudoaneurysm represents a rare, potentially catastrophic complication of arterial cannulation that has been reported after cardiac catheterization. Treatment options are limited to chemical, mechanical, and combined approaches to obliterate the radial artery pseudoaneurysm and tract. Manual compression protocols using the TR Band have been variableand anecdotal, without objective measurements of adequate compression, making this technique prone to failure (1). In this report, we present an efficient, safe, and noninvasive management for treatment of radial artery pseudoaneurysms that is cost-effective and efficient and ensures correction without occlusion of the radial artery.

Pseudoaneurysm of the Radial Artery After a Bicycle Fall

We report a case of a 64-year-old man who developed a painful pulsatile mass in the distal forearm after a bicycle fall with fracture of the wrist. Ultrasonography confirmed a 2.5-cm large pseudoaneurysm of the radial artery. The patient underwent surgical exploration. The pseudoaneurysm was resected and the defect in the arterial wall was reconstructed with an autologous saphenous vein patch. We suggest that the double arterial supply of the hand should be preserved whenever possible.

Two Rare Cases of Posttraumatic Peripheral Artery Pseudoaneurysm

Posttraumatic pseudoaneurysms of the lower limb are increasingly recognized due to the development of cross-sectional imaging. Two cases of anterior tibial artery pseudoaneurysm after blunt trauma are presented. The diagnostic technique of choice is Doppler ultrasound (US). In some cases, computed tomography angiography (CTA) or magnetic resonance angiography (MRA) is needed to identify the feeding vessel. The treatment of choice is not yet determined. Ultrasound-guided thrombin injection is widely used as first-line treatment, but some cases are refractory to this treatment. Further investigation and optimization of therapeutic technique to definitely exclude the pseudoaneurysm from the circulation may result in faster and more cost-effective treatment than US-guided thrombin injection.

"To-and-fro" waveform in the diagnosis of arterial pseudoaneurysms

Medical ultrasound imaging with Doppler plays an essential role in the diagnosis of vascular disease. This study intended to review the clinical use of “to-and-fro” waveform at duplex Doppler ultrasonography (DDU) in the diagnosis of pseudoaneurysms in the arterial vessels of upper and lower extremities, abdominal aorta, carotid and vertebral arteries as well as to review our personal experiences of “to-and-fro” waveform at DDU also. After receiving institutional review board approval, an inclusive literature review was carried out in order to review the scientific foundation of “to-and-fro” waveform at DDU and its clinical use in the diagnosis of pseudoaneurysms in various arterial vessels. Articles published in the English language between 2000 and 2013 were evaluated in this review study. Pseudoaneurysms in arterial vessels of the upper and lower extremities, abdominal aorta, carotid and vertebral arteries characterized by an extraluminal pattern of blood flow, which shows variable echogenicity, interval complexity, and “to-and-fro” flow pattern on color Doppler ultrasonography. In these arterial vessels, Duplex ultrasonography can demonstrate the degree of clotting, pseudoaneurysm communication, the blood flow patterns and velocities. Spectral Doppler applied to pseudoaneurysms lumen revealed systolic and diastolic turbulent blood flow with traditional “to-and-fro” waveform in the communicating channel. Accurate diagnosis of pseudoaneurysm by spectral Doppler is based on the documentation of the “to-and-fro” waveform. The size of pseudoaneurysm determines the appropriate treatment approach as surgical or conservative.

Pseudoaneurysm formation following a traumatic wrist laceration

Pseudoaneurysms occur secondary to partial disruption of the arterial wall. They are a commonly described complication of arterial injury, with penetrating injury and iatrogenic arterial catheterization being the most common etiologies in children. Many present weeks to months after the injury, and the initial vascular injury is often missed. The complications of pseudoaneurysm, which include thromboembolism, neurapraxia, and compartment syndrome, underscore the importance of early recognition and management. Definitive therapy consists of ultrasound-guided compression or resection and possible graft interposition. We describe a case of pseudoaneurysm formation in the radial artery of an adolescent girl 6weeks following a penetrating injury. The patient’s injury was complicated by sensory and motor deficits consistent with ulnar nerve compression. This case attests to the importance of adequately ruling out arterial injury in penetrating injury and close followup if the history is suggestive. In addition, a high index of suspicion is warranted to facilitate imaging of a pulsatile mass to avoid confusion of a thrombosed artery with an abscess.

Radial artery pseudoaneurysm: a simplified treatment method

A radial artery pseudoaneurysm represents a rare, potentially catastrophic complication of arterial cannulation that has been reported after cardiac catheterization. Treatment options are limited to chemical, mechanical, and combined approaches to obliterate the radial artery pseudoaneurysm and tract. Manual compression protocols using the TR Band (Terumo Medical Corporation, Somerset, NJ) have been variable and anecdotal, without objective measurements of adequate compression, making this technique prone to failure. In this report, we present an efficient, safe, and noninvasive management protocol using a pulse oximeter and the TR Band for treatment of radial artery pseudoaneurysms that is cost-effective and efficient and ensures correction without occlusion of the radial artery.

Effective compression bandage for repair of a complicated radial artery pseudoaneurysm

We describe a 10-week-old hemophilic infant who developed a large-sized pseudoaneurysm of the radial artery after arterial puncture. Based on our previous experience, compression bandage was elected as first-line treatment. The clinical course was complicated by skin ulceration. However, compression bandage was continued, and complete thrombosis of the pseudoaneurysm occurred after 4 weeks of treatment, preserving arterial patency. Bedside clot evacuation and enzymatic debridement promoted rapid wound healing with negligible scar formation. Compression bandage is a safe and valuable measure for repair of radial artery pseudoaneurysm, even in patients with clotting disorders. Professionals are encouraged to consider the benefit of such an artery-sparing treatment option.

Pseudoaneurysm in the hand of a three-year-old boy: a case report

BACKGROUND

Post-traumatic, true aneurysm of the hand is a well-documented phenomenon. Hypothenar hammer syndrome is often a consequence of repeated blunt trauma to the palm, but a false aneurysm, or pseudoaneurysm, of the palm is much rarer. A pseudoaneurysm is often the result of focal penetrating trauma.

OBJECTIVES

The goal of this article is to describe a rare case of a child with a pseudoaneurysm of the superficial palmar arch and his subsequent surgical treatment.

CASE REPORT

A 3-year-old boy sustained an accidental laceration to his palm while picking up a knife from a counter. The child was initially treated in a local Emergency Department (ED) with local wound care and Dermabond (Ethicon, Inc., Somerville, NJ). No imaging was undertaken at that time. The boy subsequently developed a large, pulsatile, painful mass in his palm near the site of injury, and he presented to our ED for evaluation. Using a combination of imaging modalities and a careful history, the boy was accurately diagnosed with a pseudoaneurysm of the superficial palmar arch. This lesion was subsequently successfully resected and repaired. The child has healed well after surgery, with no lasting sensory or motor deficits to the hand. To date, this is one of only two reported post-traumatic pseudoaneurysms of the palmar arch in a child in North America.

CONCLUSION

Although a rare phenomenon, pseudoaneurysm of the superficial palmar arch after local penetrating trauma remains an important item on the differential for patients presenting with palmar masses. Pseudoaneurysm can be effectively diagnosed and treated with excellent results.

Radial artery pseudoaneurysm in the intensive care unit

Pseudoaneurysms may occur at the wrist after catheterization of the radial artery but may also occur after arteriovenous shunting for dialysis or after direct trauma to an artery. Radial artery pseudoaneurysms are being increasingly reported because of widespread use of invasive monitoring. We report a case of radial artery pseudoaneurysm at the wrist related to catheterization. The pseudoaneurysm thrombosed after 6 days of external compression. In selected cases, extended external compression is a useful therapeutic option, especially in patients who are medically unfit to undergo general anesthesia or operative treatment.

Bilateral radial artery aneurysms in the anatomical snuff box seen in marfan syndrome patient: case report and literature review

We describe the first Marfan syndrome case of non-traumatic bilateral radial artery aneurysms in the anatomical snuff box. A 74-year-old woman with Marfan syndrome had a pulsatile mass in her bilateral anatomical snuff box. The color Doppler ultrasonography showed an aneurysm of radial artery located in the bilateral anatomical snuff box. Resection of the right radial artery aneurysm was completed without complications. Histopathological analysis showed a true aneurysm with atherosclerotic changes in the arterial wall. We review the literature on non-traumatic or bilateral radial artery aneurysm in the anatomical snuff box, and discuss the clinical presentation and surgical management.

Radial artery pseudoaneurysm after a single arterial puncture for blood-gas analysis: a case report

We report a case of a radial artery pseudoaneurysm complicating a single arterial puncture for blood-gas analysis that was treated with excision of pseudoaneurysm and suture of the defect of wall of radial artery. The puncture for continuous blood pressure monitoring and serial blood gas analysis have been reported in critically ill patients, but, to the best of our knowledge, there are no cases reported of pseudoaneurysm after a single arterial puncture for blood-gas analysis. In the reported case we think that the main cause of the pseudoaneurysm onset was an incorrect compression and/or a too much short time of compression of the radial artery after the puncture. Minor sequelae and rare complications may be minimized by careful attention to detail in the performance of such procedures and care of the patient also after a single arterial puncture.

Ruptured pseudoaneurysm of the radial artery

A 40-year-old man presented with a progressively increasing swelling over the ventral aspect of the right wrist of 23 days duration following a laceration. The swelling was soft, pulsatile and was intermittently bleeding, with poor distal capillary filling and cold distal extremity. Clinically it was diagnosed as pseudoaneurysm of the radial artery and was sent for a duplex scan for confirmation. The lesion ruptured in the radiology department before the scan was done, and the patient went into hypovolaemia. In view of this, the patient underwent exploration of the pseudoaneurysm under brachial block, and the radial artery was found to be transected just proximal to the dorsal branch. It was decided to repair the artery as there was no evidence of adequate circulation supply or the patency of the ulnar artery preoperatively. Doppler study at 15 and 45 days postoperatively showed good flow through, with no evidence of thrombus.

Radial artery pseudoaneurysm formation after cat bite to the wrist

Pseudoaneurysms may occur in the groin after catheterization of the femoral artery but may also occur in arteriovenous shunting for dialysis after placement of indwelling catheters or after direct trauma to an artery. We report a unique cause of radial artery pseudoaneurysm at the wrist related to a cat bite sustained by an elderly woman. The patient underwent successful operative repair of the aneurysm, with ligation of the radial artery.

Brachial Artery Pseudoaneurysm in a 6-Week-Old Infant

Trauma to the wall of an artery may lead to the development of a pseudoaneurysm. There are infrequent case reports of children who have developed pseudoaneurysms after vascular access attempts. The options for management are limited in children and even more so in neonates. We describe the presentation and management of a 6-week-old infant who had attempts at insertion of an intravenous catheter as a newborn. She presented with an enlarging mass of the right upper extremity with no palpable radial pulse on examination. Workup included radiographs, Doppler ultrasound, and magnetic resonance imaging that established the diagnosis of pseudoaneurysm of the brachial artery. She underwent a repair of the right brachial artery by identifying the site of the arterial injury and oversewing the defect in the wall. Intraoperatively, she had good arterial flow with a return of the radial pulse. The patient did well immediately postoperatively and has been followed for more than a year with normal pulses and growth of the upper extremity. Patients that have had previous attempts at vascular access and subsequently develop a mass in the area of puncture should be worked up for the potential of a pseudoaneurysm. Doppler ultrasound and magnetic resonance imaging may help with diagnosis. Primary repair is advocated in this injury to ensure adequate growth of the limb.