Distal solution for an (un)conventional radial artery complication: a case report.

IF 0.8 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal: Case Reports Pub Date : 2024-10-23 eCollection Date: 2024-11-01 DOI:10.1093/ehjcr/ytae564
Giuseppe Colletti, Gregory Angelo Sgueglia, Olivier Gach, Alexandre Natalis, Claudiu Ungureanu
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Abstract

Background: The European Society of Cardiology guidelines recommend transradial access (TRA) for coronary angiography due to its advantages, including lower mortality and bleeding complications. Arterial pseudoaneurysms are rare but challenging complications of TRA, occurring in 0.009%-0.05% of procedures. Non-surgical management, especially in cases with large (>1 mm) necks or late discovery, can be difficult due to the limited effectiveness of echo-guided compression and risks of echo-guided thrombin injection, like thrombin embolization leading to necrosis.

Case summary: An 82-year-old underwent successful non-surgical management of a large-neck pseudoaneurysm following TRA for a primary percutaneous coronary intervention of the left anterior descending artery. Clinical examination revealed a pulsatile mass at the puncture site, diagnosed via ultrasound as a pseudoaneurysm with a >1 mm neck. Through distal radial access, an initial 5 Fr sheath was upsized to 8 Fr based on ultrasound findings, achieving complete pseudoaneurysm exclusion. Follow-ups confirmed pseudoaneurysm sealing and radial artery patency.

Discussion: This case illustrates an effective non-surgical approach to managing large-neck pseudoaneurysms post-TRA, utilizing an upsized sheath technique. It underscores the importance of innovative non-surgical strategies in complex cases, providing a safe and effective alternative to traditional management methods.

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桡动脉(非)常规并发症的远端解决方案:病例报告。
背景:欧洲心脏病学会指南推荐经桡动脉入路(TRA)进行冠状动脉造影术,因为它具有死亡率和出血并发症较低等优点。动脉假性动脉瘤是经桡动脉入路冠状动脉造影术罕见但具有挑战性的并发症,发生率为 0.009%-0.05%。由于回声引导压迫的效果有限,以及回声引导凝血酶注射的风险,如凝血酶栓塞导致坏死,因此非手术治疗,尤其是颈部较大(>1 毫米)或发现较晚的病例,可能会很困难。病例摘要:一位 82 岁的老人在接受左前降支动脉原发性经皮冠状动脉介入治疗 TRA 后,成功接受了非手术治疗大颈假性动脉瘤的手术。临床检查发现穿刺部位有搏动性肿块,经超声诊断为颈部大于 1 毫米的假性动脉瘤。根据超声检查结果,通过桡动脉远端入路,将最初的5 Fr鞘扩大到8 Fr,完全排除了假性动脉瘤。随访证实假性动脉瘤被封堵,桡动脉通畅:本病例展示了一种有效的非手术治疗方法,即利用加大鞘管技术治疗桡动脉后大颈假性动脉瘤。它强调了创新非手术策略在复杂病例中的重要性,为传统治疗方法提供了安全有效的替代方案。
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来源期刊
European Heart Journal: Case Reports
European Heart Journal: Case Reports Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.30
自引率
10.00%
发文量
451
审稿时长
14 weeks
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