Distal Radial Access for Percutaneous Endovascular Repair of a Radial Artery Pseudoaneurysm

J INVASIVE CARDIOL 2020;32(7):E198.

Key words: cardiac imaging, pseudoaneurysm

An 82-year-old man presented with a pulsatile mass at the puncture site, following transradial percutaneous coronary intervention. Ultrasound confirmed a pseudoaneurysm (Figure 1A), which was treated with manual compression. Due to pseudoaneurysm recurrence, we opted for percutaneous repair, which we have previously used as an alternative to surgical repair.

To minimize concerns for hand ischemia caused by accessing the ipsilateral ulnar artery, we used a distal radial approach through the anatomical snuffbox. Contrast injection through a 6 Fr sheath confirmed the pseudoaneurysm (Figure 1B). Using a 3.5,  6 Fr EBU catheter, a 3.5 x 18 mm covered stent was implanted over the pseudoaneurysm neck and was subsequently postdilated with a 3.5 x 20 mm balloon (Video 1). Due to residual leakage attributable to proximal stent migration, we used a balloon to retrieve the stent (Video 2), and we finally expanded a second 3.5 x 18 mm covered stent distal to the first stent with some overlap (Figure 1C). After successful isolation of the aneurysm sac (Figure 1D; Video 3), the pseudoaneurysm was evacuated and mild external compression was applied. 

Percutaneous pseudoaneurysm repair through the ipsilateral ulnar artery is an alternative to surgical repair; however, distal radial access, as described in this case, may offer increased safety.

View the Supplemental Video Series Here

From the Cardiology Department, Athens Red Cross Hospital, Athens, Greece.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein. 

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted November 14, 2019.

Address for correspondence: Theodoros Zografos, MD, 1st Cardiology Department, Red Cross Hospital, 1 Athanasaki St, 11521, Athens, Greece. Email: theodoroszografos@gmail.com