A Novel Non-Surgical Treatment for Iatrogenic Radial Artery Pseudoaneurysm: A Case Series

Iatrogenic radial artery pseudoaneurysm (iRAP) is a rare but potentially devastating complication after transradial access. Spontaneous thrombosis rarely occurs in lesions > 2 cm in size, surgery is invasive, and USG-guided thrombin injection risks distal embolisation due to the short necks of most iRAP.

We describe a non-surgical approach by Differential Radial Artery Isolation and NEedle Decompression (DRAINED) for treating iRAP. The neck of the iRAP was confirmed by Doppler ultrasound. Two pneumatic hemostatic compression bands (TR band, Terumo) were inflated proximal and disteal to the iRAP to occlude antegrade and retrograde radial flow respectively, mimicking surgical isolation of the iRAP segment. Ultrasound-guided needle aspiration of its content under aseptic technique was followed by an additional compression band placed directly over the iRAP to prevent reaccumulation. After 2 h, all three bands were gradually deflated. Digital perfusion was continuously monitored by plethysmography on pulse oximetry.

Medical records of 6 patients (50% female, mean age 72.5) with iRAP treated by DRAINED from 2018 to 2024 were retrospectively reviewed. Patient demographics, procedural details, and ultrasound records were identified. All underwent percutaneous coronary intervention, and 83.3% had 7 Fr radial sheath insertion. Fifty percent received double-antiplatelet post-procedure and 50% received anticoagulation. All patients experienced resolution of iRAP after DRAINED, and there were no complications, such as radial artery thrombosis or distal embolisation.

DRAINED demonstrated safety and efficacy in our cohort of patients suffering iRAP after transradial access.