Indian Journal of Vascular and Endovascular Surgery

CASE REPORT
Year
: 2016  |  Volume : 3  |  Issue : 3  |  Page : 104--106

Bilateral Radial Artery Pseudoaneurysms Following Arterial Cannulation: A Rare Case Report


Devender Singh 
 Department of Vascular Surgery, Yashoda Super Speciality Hospital, Hyderabad, Telangana, India

Correspondence Address:
Dr. Devender Singh
Department of Vascular Surgery, Yashoda Super Speciality Hospital, Hyderabad, Telangana
India

Abstract

The use of arterial cannulae for blood pressure monitoring and repeated arterial blood gas sampling is increasing. The placement and maintenance of such cannulae is not without complication. To our knowledge, a case of synchronous bilateral radial artery pseudoaneurysms is a very rare presentation and only couple of cases are reported in the literature.



How to cite this article:
Singh D. Bilateral Radial Artery Pseudoaneurysms Following Arterial Cannulation: A Rare Case Report.Indian J Vasc Endovasc Surg 2016;3:104-106


How to cite this URL:
Singh D. Bilateral Radial Artery Pseudoaneurysms Following Arterial Cannulation: A Rare Case Report. Indian J Vasc Endovasc Surg [serial online] 2016 [cited 2020 Apr 2 ];3:104-106
Available from: http://www.indjvascsurg.org/text.asp?2016/3/3/104/186719


Full Text

 Introduction



The use of arterial cannulae for blood pressure monitoring and repeated arterial blood gas sampling is increasing. The placement and maintenance of such cannulae are not without complication. To the best of our knowledge, a case of synchronous bilateral radial artery pseudoaneurysms is a very rare presentation and only couple of cases is reported in literature.

 Case Report



A 24-year-old female, who had required 21 days' ventilatory support to manage peripartum fulminant hepatic failure, was referred for a vascular surgical opinion of bilateral pulsatile swellings over both wrists. While in Intensive Care Unit, she had alternate left and right 20 G radial arterial cannulae, each for 7 days. She was referred 8 days after removal of a second left radial arterial cannula.

Over a period of days, before surgical consultation, the swellings over both wrists expanded rapidly to 3 cm diameter, resulting in pain due to increasing pressure over the overlying skin [Figure 1]. Allen's test suggested bilateral radial dominance. Preoperative arteriography confirmed pseudoaneurysm of the radial artery on both wrists [Figure 2]. Immediate repair involved elliptical incision over the skin, resection of the pseudoaneurysms and end-to-end reconstruction of the radial artery on the right side, and repair with an interposition vein graft on the left side [Figure 3] and [Figure 4]. Postoperative recovery was uncomplicated [Figure 5].{Figure 1}{Figure 2}{Figure 3}{Figure 4}{Figure 5}

 Discussion



The complications of radial arterial puncture include thrombosis, hemorrhage, and pseudoaneurysm formation.[1] Pseudoaneurysms are caused by a perforation of the arterial wall followed by the development of an enlarging hematoma. The hematoma, surrounded by connective tissue, undergoes organization and central liquefaction to form a sac. A pseudoaneurysm results when this sac remains in continuity with the vessel lumen. The risk of pseudoaneurysm formation following arterial puncture is increased in patients as a result of low platelet counts or sometimes inadequate pressure following punctures. Local infection also causes increase in the incidences of pseudoaneurysm.[2]

Acute fulminant hepatitis in pregnancy is a dreadful condition associated with high morbidity and mortality. Patients with disseminated intravascular coagulation have increased risk of pseudoaneurysms after an arterial puncture.

Pseudoaneurysm of the radial artery following cannulation was first reported in 1973.[3] Treatment involves resection of the diseased artery, often followed by arterial ligation without distal ischemic sequelae.[2]

This is due to ulnar arterial supply via the deep palmar arch. However, in 12% of patients, the ulnar artery does not communicate with the arch [4] and in these patients vascular reconstruction is necessary.[2] This is achieved by end-to-end anastomosis or an interposition vein graft.

Before cannulation, the arterial supply to the hand should be assessed using Allen's test,[2],[3] whereby both the radial and ulnar arteries are compressed at the wrist, the hand is blanched by direct pressure or wrist, the hand is blanched by direct pressure or clenching of the fist, and each vessel is released to observe capillary return. If the hand remains blanched for longer than 15 s during occlusion of the radial artery, ulnar flow is deemed insufficient and radial artery cannulation should not be attempted.[2] Vigilance in aseptic technique for arterial puncture and pressure over the vessel following cannula removal should reduce the risks of wound infection, hematoma formation and subsequent development of a pseudoaneurysm; performing Allen's test before cannulation may reduce the need for vascular reconstruction when simple arterial ligation may suffice.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Bedford RF, Wollman H. Complications of percutaneous radial-artery cannulation: An objective prospective study in man. Anesthesiology 1973;38:228-36.
2Russell RE, Steichen JB, Zook EG. Radial arteries pseudoaneurysm. Their diagnosis, treatment, prevention. Orthop Rev 1979;8:49-50.
3Mathieu A, Dalton B, Fischer JE, Kumar A. Expanding aneurysm of the radial artery after frequent puncture. Anesthesiology 1973;38:401-3.
4Coleman SS, Anson BJ. Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obstet 1961;113:409-24.