Managing Postangiography Radial Artery Pseudoaneurysms: Systematic Review of the Published Literature

With the growing use of radial access in coronary angiography, rare but significant complications such as radial artery pseudoaneurysms are increasingly encountered. This arises when arterial wall disruption leads to a soft tissue hematoma with persistent communication with the arterial lumen. Literature on management remains scarce and consists of a few case reports.

We conducted a systematic review of cases describing radial artery pseudoaneurysms following coronary angiography from January 1992 to February 2025 using PubMed, Scopus, and Google Scholar. Data extracted included patient demographics, anticoagulant use, clinical presentation, pseudoaneurysm dimensions, timing of symptom onset, and treatment strategies with associated outcomes.

A total of 56 publications comprising 75 patients were analyzed. Mean age was 70.9 years, with predominance in women (58.3%), albeit statistically nonsignificant (P = .157). All patients had access site swelling, and half had pain. Most pseudoaneurysms developed within the first month postprocedure (81.6%). Chronic anticoagulant use was reported in 58.3% of patients, with warfarin being the most common agent. Four primary treatment modalities were reported: compression (n = 24), thrombin injection (n = 9), percutaneous interventions (n = 6), and surgery (n = 36). Compression was the most frequently used but least effective method, with a 58.5% success rate as compared to 100% in the other methods.

Radial artery pseudoaneurysms are rare but potentially serious complications of transradial coronary procedures. Although compression is commonly attempted, invasive treatments offer superior efficacy.