Radial artery pseudoaneurysm (PSA) may be a rare complication post heart catheterization, but with the increase use of radial artery access, the incidence may be more common. This a case study of diagnosing a radial artery PSA by color flow duplex imaging (CDI) months after the heart catheterization with discussion of treatment options and follow-up.
The patient was referred to the Vascular lab for an arterial CDI to rule out a PSA of the right radial artery 4 months after using this site for heart catheterization access. Patient complaints of pain and lump at wrist. Previous ultrasound imaging of the right radial artery showed small extravasation of blood outside the radial artery suggesting hematoma. Previous CTA was non-diagnostic. CDI was utilized confirm PSA size, flow, location and native artery flow.
CDI revealed a right radial artery PSA. Using both linear 12-3mHz and 15-7 mHz transducers, a 2.0 cm PSA off the right radial artery, with 370 cm/s to/fro waveform. The feeder off the radial artery to the PSA measured 2.6 mm in length and 3.1 mm in size with a velocity of 418 cm/s. The radial artery distal and proximal to the PSA showed normal triphasic waveform with velocities 102-80 cm/s. Radial vein was compressible with venous flow. Treatment options for PSA closure were discussed. These included conservative observation with mechanical compression therapy, thrombin injection under ultrasound guidance and open surgical repair. Based on the age of PSA and sonographic findings, an open repair of the PSA was performed with success and normal radial artery flow.
As radial artery access for heart catheterization is used more frequently, we may perform imaging techniques to check for PSA, hematoma or arterio-venous fistula. CDI is very diagnostic in confirming PSA and useful in treatment and follow up.
Nina Dongilli, RN, RVT, Allegheny Health Network