Radial Artery Pseudoaneurysm Following Transradial Catheterization: Recognition, Management, and Prevention

Transradial cardiac catheterization is recommended over femoral artery catheterization for patients with acute coronary syndrome due to lower rates of bleeding and vascular complications. Despite its favorable safety profile, radial artery-specific complications occur, including spasm, occlusion, arteriovenous fistula, perforation, and pseudoaneurysm. Radial artery pseudoaneurysm (RAP) is an uncommon but potentially morbid access-site complication that remains incompletely characterized, with limited practical guidance on diagnosis and management. This review synthesizes published clinical experience on RAP following transradial catheterization, with key considerations for diagnosis, risk stratification, and management. Across published experience, patients with RAP most commonly present with localized pain, swelling, or a pulsatile mass at the access site, with symptom onset ranging from hours to weeks after catheterization. Duplex ultrasonography is the primary diagnostic modality, allowing assessment of pseudoaneurysm size, neck morphology, and flow characteristics. Management strategies range from observation and mechanical compression to ultrasound-guided thrombin injection and surgical repair, with treatment selection guided by lesion size, symptoms, stability, anticoagulation status, and the need to preserve the radial artery. Early recognition with ultrasound and individualized treatment can prevent progression and associated morbidity as transradial access continues to expand.