Percutaneous treatment of iatrogenic radial artery pseudoaneurysms using percutaneous thrombin injection

A 75-year-old man with a history of percutaneous coronary intervention using radial access was referred for pre-planned follow-up coronary angiography at 1 year. Coronary angiogram through the right distal radial artery using a 6-Fr sheath showed no evidence of in-stent restenosis. The patient complained post-procedure pain and swelling in the forearm; subsequent angiography revealed a perforation of the radial artery (Panel A) which was wrapped with elastic bandages. Puncture site hemostasis was also covered with an elastic bandage for 3 hours. The next day, physical examination showed severe forearm and hand hematoma (Panel B) and two pulsatile masses located in the middle of the forearm and the puncture site. Ultrasound demonstrated one pseudoaneurysm at the forearm, measuring 22 mm×15 mm (Panel C), which was sealed by injecting 300 units of thrombin into the pseudoaneurysm under ultrasound guidance (Panel D) with excellent morphological results. Another pseudoaneurysm, measuring 17 mm×10 mm (Panel E) located in distal puncture site, was obliterated by ultrasound-guided percutaneous 200 units thrombin injection with distal radial artery patency (Panels F, G, H). The patient was discharged on day 2. At 12-month follow-up, the patient is asymptomatic (Panel I). Access-related pseudoaneurysms, though rare, do occur. Ultrasound-guided thrombin injection is the safer and more effective choice of treatment in pseudoaneurysms after distal radial artery procedures. Consent: Written consent for submission and publication of this case report including images and associated text has been obtained from the patient in line with COPE guidance. Conflict of interest: None declared. Funding: The work was supported by the Capital’s Funds for Health Improvement and Research (No. 2022-2-7086).