Unusual Complication of Transradial Coronary Angiography

Case report

A 68-year-old male with diabetes and hypertension underwent a coronary angiogram, through the right radial artery approach, because of inducible ischaemia on stress testing. He had significant triple vessel disease for which revascularisation was advised. Two weeks later he presented with progressively increasing swelling at the radial puncture site. A 2.4 × 1.3 cm pulsatile swelling was seen (Figure 1, movie 1 (You can find the movies on: http://www.cardiovascmed.ch/for-readers/multimedia)). The skin over the swelling was stretched and shiny. Colour Doppler imaging revealed a pseudo-aneurysm originating from radial artery through a 3 mm neck (Figure 2, movie 2 (You can find the movies on: http://www.cardiovascmed.ch/for-readers/multimedia)). There was no evidence of infection or distal thromboembolism. On application of firm manual pressure for 15 minutes followed by a pressure bandage the pseudoaneurysm was completely obliterated.

Radial artery pseudo-aneurysm is an uncommon complication of transradial interventionw. Inadequate application of pressure following the coronary angiogram is the probable cause of this pseudoaneurysm. Early recognition and treatment is important to prevent infection, thromboembolism to the digits and rupture.