Yenmin2020 PDF
Yenmin2020 PDF
Yenmin2020 PDF
CASE REPORT
Introduction: True non-traumatic radial artery aneurysms (RAAs) are extremely rare, and few cases have been
described. The majority of RAAs are post-traumatic or iatrogenic pseudo-aneurysms following arterial
cannulation. However, RAAs due to other causes have also been described. Here a rare case of true idiopathic
distal RAA, which was managed by surgical resection and repair with interposition vein graft, is described.
Report: A 62 year old female with a known medical history of hypertension and hyperlipidaemia presented with
left wrist swelling of one year duration, associated with a pulsatile lump that was increasing in size. Duplex
ultrasound and computed tomography angiography revealed a distal RAA. She underwent open surgical resection
and repair with interposition vein graft using the distal left cephalic vein. Histopathology of the specimen
revealed an aneurysm with atherosclerosis. She recovered well post-operatively with no complications.
Discussion: True idiopathic RAAs are rare. Surgical treatment is almost always recommended in view of the risk of
complications. A case of true idiopathic distal RAA is presented here, which was managed successfully by surgical
resection and repair with interposition vein graft.
Ó 2020 Published by Elsevier Ltd on behalf of European Society for Vascular Surgery. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Article history: Received 10 July 2020, Revised 3 October 2020, Accepted 4 November 2020,
Keywords: Idiopathic, Interposition graft, Radial artery, True aneurysm
Figure 1. Pre-operative photographs of the patient’s left hand showing a lump in the anatomical snuffbox (red arrows).
achieve a tension free repair, a segment of the left cephalic palpated radial pulse was strong with no neurovascular
vein at the incision site was harvested, and the radial artery deficits, and Duplex ultrasound showed that the repair was
defect was repaired with interposition vein graft by an end patent. Histopathology of the specimen revealed an aneu-
to end anastomosis (Fig. 3). The radial pulse was strong. rysm with atherosclerosis (Fig. 4).
Post-operatively, she recovered well with no complications.
She was discharged with analgesia, a short course of anti- DISCUSSION
biotics and her usual medications for hypertension (los- True RAAs are rare with a prevalence of 2.9% among all
artan) and hyperlipidaemia (atorvastatin). Aspirin was not aneurysms affecting the upper extremities and have only
prescribed due to allergy. During the latest follow up visit been described in few case reports in the current literature
(one month post-operatively) there were no complaints, the (Table 1). The majority of RAAs are post-traumatic or
Figure 2. (A) Duplex ultrasound and (B) computed tomography angiogram showing the distal radial artery aneurysm in the area of the
anatomical snuffbox.
36 YM Madeline Chee et al.
A B
C D
Figure 3. Intra-operative photographs showing (A,B) the radial artery aneurysm identified with proximal and distal control achieved, (C)
completed repair with cephalic vein interposition graft with end to end anastomosis, and (D) the resected radial artery aneurysm.
Figure 4. Histopathology images of the excised radial artery aneurysm with H&E (left) and EVG (right) stains. Sections of the vessel show
fibrotic and focally thinned out wall with loss of internal elastic lamina. There is also intimal thickening and atherosclerotic changes.
Table 1. Cases of true radial artery aneurysms published in English language to date.
37
Continued
Table 1-continued
38
No. Authors Age Sex Size of aneurysm (largest Aneurysm location Aetiology Diagnostic modality Treatment Outcome
diameter, mm)
15. Santis et al. 48 F Multiple small fusiform Multiple e most proximal Neurofibromatosis I CT angiography Surgical excision and Discharged 10 days post-
(2013) aneurysms located 3cm below radial artery ligation op, no complications at
brachial artery bifurcation six months follow up
16. Shaabi et al. 65 F 20 Anatomical snuffbox Idiopathic CT angiography Surgical excision and Post-op uneventful
(2014) radial artery ligation
17. DeŞer et al. 25 M 20 Wrist Behçet’s disease US duplex Surgical excision and Post-op uneventful
(2017) radial artery ligation
18. Al-Zoubi et al. 61 M 30 Wrist Idiopathic US Doppler, CT Surgical excision and Discharged same day, no
(2018) angiography primary end to end post-op complications
anastomosis
19. Erdogan et al. 52 M 14 Anatomical snuffbox Idiopathic CT angiography Surgical excision with Discharged three days
(2018) primary end to end post-op, no lesion at three
anastomosis months on CT
reconstruction
20. Ghaffarian 25 M 6.3 Anatomical snuffbox Idiopathic US duplex, angiography Surgical excision and No complications at 10
et al. (2018) repair with interposition months post-op, duplex
great saphenous vein US shows patent vein
graft graft with normal hand
perfusion
21. Maalouly et al. 73 F 15 Anatomical snuffbox Idiopathic CT angiography Surgical excision and Discharged two days post-
(2019) radial artery ligation op, uneventful
22. Umana et al. 83 M 20 Proximal radial artery just Idiopathic US duplex, CT Surgical excision and Discharged 24h post-op,
(2019) distal to elbow crease, angiography primary end to end US duplex at six months
8cm distal to brachial anastomosis post-op shows patent
artery bifurcation radial artery
23. Wu et al. 65 M Not stated Wrist Snake bite Not done e diagnosed Surgical excision and Right forearm amputated
(2020) intra-op during radial artery ligation
emergency surgery
24. Chee et al. 62 F 12 Anatomical snuffbox Idiopathic US duplex, CT Surgical excision and Discharged one day post-
(2020) angiography repair with interposition op, no post-op
cephalic vein graft complications
CT ¼ computed tomography; US ¼ ultrasound.