A Case Report of Radial Artery Pseudoaneurysm After Repeated Radial Puncture for Arterial Blood Gas
DOI:
https://doi.org/10.20344/amp.19697Keywords:
Aneurysm, False/diagnostic imaging, Blood Gas Analysis/adverse effects, Emergency Service, Hospital, Point-of-Care Systems, Radial Artery/diagnostic imaging, UltrasonographyAbstract
Arterial blood gas, with subsequent radial arterial puncture as a simple access point, comprises a ubiquitous medical procedure in the diagnostic workup of patients admitted to the emergency department with dyspnea. Despite being a relatively safe and technically straightforward procedure, due to its considerable use, it is of vital importance to be able to promptly recognize its potential complications. We present the case of a 96-year-old female patient admitted to the emergency department with dyspnea and cough who underwent left radial arterial puncture for arterial blood gas. A total of three puncture attempts were performed until arterial blood was collected. Roughly two weeks upon observation, the patient was readmitted to the emergency department after the insidious appearance of a painful swelling in the left wrist, with progressive worsening since hospital discharge. On physical examination, a painful erythematous pulsatile swelling in the left wrist’s volar aspect was observed, and further point-of-care ultrasound evaluation documented a cysticlike collection, communicating with the radial artery’s lumen, and suggesting the probable diagnosis of iatrogenic radial pseudoaneurysm. The patient was hospitalized and underwent surgical resection of radial pseudoaneurysm, with subsequent arterial repair. Although severe complications from arterial blood gas have a low incidence rate, prompt diagnosis and management are required. Therefore, point-of-care ultrasound, as an additional diagnostic tool, may play a role in minimizing the risk of procedural complications.
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Dev SP, Hillmer MD, Ferri M. Arterial puncture for blood gas analysis. N Engl J Med. 2011;364:e7. DOI: https://doi.org/10.1056/NEJMvcm0803851
Kumar AJ, Jones LE, Kollmeyer KR, Feldtman RW, Ferrara CA, Moe MN, et al. Radial artery access for peripheral endovascular procedures. J Vasc Surg. 2017;66:820-5. DOI: https://doi.org/10.1016/j.jvs.2017.03.430
Mohapatra A, Saadeddin Z, Avgerinos ED, Al-Khoury GE, Hager ES, Eslami MH. Utilization and outcomes of radial artery access for lower extremity endovascular intervention. Ann Vasc Surg. 2021;77:94-100. DOI: https://doi.org/10.1016/j.avsg.2021.06.005
Bhat T, Teli S, Bhat H, Akhtar M, Meghani M, Lafferty J, et al. Access-site complications and their management during transradial cardiac catheterization. Expert Rev Cardiovasc Ther. 2012;10:627-34. DOI: https://doi.org/10.1586/erc.12.16
Agostoni P, Biondi-Zoccai GG, de Benedictis ML, Rigattieri S, Turri M, Anselmi M, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures: systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol. 2004;44:349-56. DOI: https://doi.org/10.1016/j.jacc.2004.04.034
Russo G, Cherubini A, Fisicaro M, Cioffi G, di Lenarda A. Radial pseudoaneurysm after a puncture for blood gas analysis. Am J Emerg Med. 2016;34:757. DOI: https://doi.org/10.1016/j.ajem.2015.07.064
Patel KN, Gandhi SP, Sutariya HC. Radial artery pseudoaneurysm: a rare complication after a single arterial puncture for blood-gas analysis. Indian J Crit Care Med. 2016;20:622-6. DOI: https://doi.org/10.4103/0972-5229.192066
Sanmartín M, Cuevas D, Goicolea J, Ruiz-Salmerón R, Gómez M, Argibay V. Vascular complications associated with radial artery access. Rev Esp Cardiol. 2004;57:581-4. DOI: https://doi.org/10.1016/S1885-5857(06)60634-8
Collins N, Wainstein R, Ward M, Bhagwandeen R, Dzavik V. Pseudoaneurysm after transradial cardiac catheterization: case series and review of the literature. Catheter Cardiovasc Interv. 2012;80:283-7. DOI: https://doi.org/10.1002/ccd.23216
Bouch DC, Hall A. Ultrasound diagnosis of a false radial artery aneurysm in ICU. Anaesthesia. 2006;61:1018. DOI: https://doi.org/10.1111/j.1365-2044.2006.04814.x
Krueger K, Zaehringer M, Strohe D, Stuetzer H, Boecker J, Lackner K. Postcatheterization pseudoaneurysm: results of US-guided percutaneous thrombin injection in 240 patients. Radiology. 2005;236:1104-10. DOI: https://doi.org/10.1148/radiol.2363040736
Leone V, Misuri D, Console N. Radial artery pseudoaneurysm after a single arterial puncture for blood-gas analysis: a case report. Cases J. 2009;2:6890. DOI: https://doi.org/10.4076/1757-1626-2-6890
Caroselli C, Blaivas M, Marcosignori M, Chen YT, Falzetti S, Mariz J, et al. Early lung ultrasound findings in patients with covid-19 pneumonia: a retrospective multicenter study of 479 patients. J Ultrasound Med. 2022;41:2547-56. DOI: https://doi.org/10.1002/jum.15944
Caroselli C, Blaivas M, Falzetti S. diagnostic imaging in newborns, children and adolescents infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): is there a realistic alternative to lung high-resolution computed tomography (HRCT) and chest X-rays? A systematic review of the literature. Ultrasound Med Biol. 2021;47:3034-40. DOI: https://doi.org/10.1016/j.ultrasmedbio.2021.07.015
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