Endovascular coil embolisation of radial artery pseudoaneurysm: a case report and literature review

Abstract

Background: Radial artery pseudoaneurysm (RAP) is a rare but recognised complication of transradial percutaneous coronary intervention (PCI) with an incidence of 0.009–0.2%. Management depends on pseudoaneurysm size, morphology and patient factors. While conservative measures are often effective for small lesions, larger or symptomatic pseudoaneurysms may require surgical or endovascular intervention. Case report: A 77-year-old woman developed a right radial artery pseudoaneurysm following transradial PCI. Initial duplex ultrasound demonstrated a 16 × 10 × 13 mm pseudoaneurysm, which was managed conservatively. Two weeks later she presented with worsening wrist pain, swelling and extensive bruising. Repeat ultrasound demonstrated enlargement to 45 × 21 × 29 mm with a 16 mm neck, making thrombin injection unsuitable. Owing to recent myocardial infarction and high anaesthetic risk, open surgical repair was considered inappropriate. A digital subtraction angiogram confirmed adequate ulnar collateral circulation. Following multidisciplinary discussion, endovascular coil embolisation of the radial artery was performed successfully using detachable Ruby coils. Post-procedural angiography and duplex ultrasound confirmed complete occlusion of the radial artery and pseudoaneurysm without evidence of hand ischaemia. The patient recovered without complications and was discharged four days later. Conclusion: This case demonstrates that endovascular coil embolisation is a safe and effective treatment for enlarging radial artery pseudoaneurysms in carefully selected patients unsuitable for open surgery. Pre-procedural assessment of collateral hand perfusion and multidisciplinary decision-making are essential to achieve favourable outcomes.