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Anesthesiology:
doi: 10.1097/ALN.0b013e318279f925
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Radial Artery Pseudoaneurysm: A Rare Complication with Serious Risk to Life and Limb

Truong, Angela T. M.D.*; Thakar, Dilip R. M.D.

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A 73-YR-OLD man presented for lung resection. Medical history included hypertension and coronary artery disease. Using the over-the-needle-technique, a 20-G angiocatheter was inserted in the left radial artery with one attempt for monitoring. It was removed 2 days later. The following day, erythema and induration appeared at the puncture site (fig. A). Wound cultures grew Staphylococcus aureus. An ultrasound was performed and a pseudoaneurysm was detected (fig. B). The patient underwent surgical resection of the pseudoaneurysm (fig. C) without sequelae to the involved upper extremity.
With a reported incidence of 0.048%,1 radial artery pseudoaneurysm is a rare but serious complication of arterial cannulation, a commonly performed procedure in anesthesia practice. In contrast to a true aneurysm, which involves dilatation of all layers of the arterial wall, a pseudoaneurysm is a collection of blood that communicates with the arterial lumen without being enclosed by the arterial wall. On ultrasound, swirling blood flow is seen within the pulsatile mass.2 Its pathogenesis involves trauma to the arterial wall and catheter site infection. Prolonged duration of catheterization and length of hospitalization have been shown to be risk factors for developing catheter-related infections. Risk factors for pseudoaneurysm formation include S. aureus infection and persistent bacteremia after catheter removal.3 Delayed diagnosis may lead to compression ischemia and sepsis. Once a pseudoaneurysm has formed, surgical treatment is usually needed because conservative management carries a high risk of complications such as pseudoaneurysm rupture and thrombus propagation.
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References

1. Falk PS, Scuderi PE, Sherertz RJ, Motsinger SM. Infected radial artery pseudoaneurysms occurring after percutaneous cannulation. Chest. 1992;101:490–5

2. Rozen G, Samuels DR, Blank A. The to and fro sign: The hallmark of pseudoaneurysm. Isr Med Assoc J. 2001;3:781–2

3. Ganchi PA, Wilhelmi BJ, Fujita K, Lee WP. Ruptured pseudoaneurysm complicating an infected radial artery catheter: Case report and review of the literature. Ann Plast Surg. 2001;46:647–50

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