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Published on: September 20, 2020
Essential Thrombocythemia-Associated Distal Radial Pseudoaneurysm Treated With Thrombin Injection
Hiroki Saito1, Kaito Yamada1, Yuta Kagaya1
1Department of Cardiology, Iwate Prefectural Central Hospital, Morioka, Japan.
Background:
Distal radial artery access is associated with a low complication rate and infrequently leads to pseudoaneurysm formation. Consequently, the clinical characteristics of pseudoaneurysms in essential thrombocythemia (ET) are not well characterized.
Case Summary:
A 79-year-old woman with ET developed a pulsatile wrist mass 2 weeks after coronary angiography via distal radial artery access. Imaging revealed a 17-mm pseudoaneurysm. Conservative compression was unsuccessful. The initial thrombin injection resulted in partial thrombosis with distal escape and re-entry flow. A subsequent injection with manual proximal radial compression achieved complete thrombosis without complications.
Discussion:
In ET, qualitative platelet dysfunction may compromise thrombus stability after thrombin injection. Proximal radial compression is crucial in distal radial pseudoaneurysms to prevent distal escape and achieve durable thrombosis.
Take-Home Message:
Because ET can compromise thrombus stability, sufficient inflow reduction is essential for successful thrombin injection in distal radial pseudoaneurysms.
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