What are the signs and symptoms of radial artery aneurysm after cardiac catheterization?

From the Guidelines

Radial artery aneurysm after cardiac catheterization is a rare but potentially serious complication that typically presents with a pulsatile mass or swelling at the catheterization site, accompanied by pain, tenderness, or discomfort in the wrist area, as reported in the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention 1. The signs and symptoms of radial artery aneurysm after cardiac catheterization may include:

• A visible bulge that expands with each heartbeat
• Redness, warmth, or bruising around the site
• Paresthesia (numbness or tingling) in the hand or fingers due to compression of nearby nerves
• Diminished pulse distal to the aneurysm
• Compromised circulation to the hand
• Skin ulceration over the aneurysm These symptoms usually develop within days to weeks after the procedure, though some may appear months later. The aneurysm forms due to incomplete sealing of the arterial puncture site, allowing blood to leak into surrounding tissues and form a contained hematoma that communicates with the arterial lumen. Risk factors for radial artery aneurysm include inadequate compression after catheter removal, anticoagulation therapy, multiple puncture attempts, and large catheter size, as discussed in the context of vascular complications from PCI in the 2011 guideline 1. Any persistent or growing mass at a catheterization site should be promptly evaluated with ultrasound to confirm the diagnosis and determine appropriate management. It is worth noting that the incidence of vascular complications, including radial artery aneurysm, has decreased with time and the use of radial site access, which decreases the rate of access-related bleeding and complications compared with femoral access, as reported in the 2011 ACCF/AHA/SCAI guideline 1.

From the Research

Signs and Symptoms of Radial Artery Aneurysm

• Pain
• Swelling
• Haematoma of the arm 2

Diagnosis

• Doppler ultrasonography is used to diagnose radial artery pseudoaneurysm 2, 3

Treatment Options

• Surgical treatment has been considered the gold standard, but new and less invasive strategies have been proposed, including:
  • Ultrasound-guided compression 4, 3
  • Local injection of thrombin 2, 5, 6
  • Manual compression protocols using the TR Band 4
  • Ultrasound-guided differential compression 3

Predictors of Treatment Failure

• Age: younger age is a predictor of primary failure 6
• Anteroposterior diameter: larger diameter is a predictor of primary failure 6
• Neck diameter: larger diameter is a predictor of primary failure 6