Radial Artery Pseudoaneurysm With Individualized Non-Operative Management: A 4-Case Series

BACKGROUND Radial artery pseudoaneurysm (RAP) is an uncommon complication of radial arterial access. Although rarely life-threatening, it can cause significant morbidity. With the increasing use of radial access for coronary and endovascular procedures, arterial blood gas sampling, and invasive hemodynamic monitoring, RAP remains a potential access-site complication. Given its rarity, the literature on its management is limited and consists mainly of case reports and small case series. We report 4 cases of iatrogenic RAP with different non-operative management. CASE REPORT Four patients developed RAP following radial arterial access for intra-arterial blood pressure monitoring or coronary angiography. In Case 1, ultrasound-guided compression (UGC) was chosen because of poor collateral hand circulation and concerns for hand ischemia with thrombin injection, resulting in successful thrombosis of the pseudoaneurysm. Cases 2 and 3 underwent ultrasound-guided thrombin injection (UGTI), with Case 3 requiring repeat injection following recanalization. Case 4 had a large, flat-appearing pseudoaneurysm that was unsuitable for direct thrombin injection; balloon-assisted thrombin injection was attempted to preserve the radial artery but was unsuccessful, and a covered stent was deployed for exclusion of the pseudoaneurysm. CONCLUSIONS A range of non-operative approaches can be used in the management of RAP, depending on the clinical and anatomical circumstances. UGC and UGTI can achieve successful thrombosis, while endovascular techniques can provide an alternative when initial treatment is unsuccessful or the anatomy is challenging. Further studies are needed to better define the outcomes of these approaches and to establish a standardized treatment algorithm for RAP.