Pseudoaneurysm Formation After Cardiac Catheterization Using the Distal Transradial Approach

J INVASIVE CARDIOL 2019;31(8):E257.

Key words: complication, distal transradial access

A 77-year-old woman with exertional dyspnea, diagnosed with drug-refractory hypertrophic obstructive cardiomyopathy, underwent percutaneous transluminal septal myocardial ablation via bilateral distal transradial approach using 5 Fr pigtail and 7 Fr SL4 guiding catheters with 5 Fr and 7 Fr Glidesheath Slender (Terumo). Ethanol ablation was performed during septal branch occlusion using a 1.5 mm over-the-wire balloon. The patient’s resting pressure gradient in the left ventricular outflow tract markedly decreased. Hemostasis was achieved within 2 hours with compression using a hemostatic pad and elastic bandages. Routine vascular ultrasound of the access site on the following morning revealed accidental pseudoaneurysm formation (Figure 1A and Video 1). Close physical examination confirmed a small pinpoint hematoma <3 mm in diameter with faint bruit at the insertion point. Subsequently, ultrasound-guided compression (Figure 1B and Video 2) resolved the blood flow between the pseudoaneurysm and the distal radial artery after 10 minutes (Video 3). Two additional hours of compression using a hemostatic pad and elastic bandage were performed. Vascular ultrasound on day 7 at discharge revealed a healed pseudoaneurysm (Figure 1C).

The distal radial artery is a new approach site for coronary intervention, with reported benefits of reduced risk of radial artery occlusion, bleeding, and vascular access-site complications. To our knowledge, this is the first case report of pseudoaneurysm formation after cardiac catheterization through the distal radial artery, probably owing to its smaller size, which was easily treated by external compression.

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From the Department of Cardiology, Sakurakai Takahashi Hospital, Hyogo, Japan.

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 submitted July 1, 2019, provisional acceptance given July 4, 2019, final version accepted July 8, 2019.

Address for correspondence: Yukio Mizuguchi, MD, Department of Cardiology, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Suma-ku, Kobe, Hyogo 654-0026, Japan. Email: yukiomizuguchi@gmail.com