Clinical Presentation, Management, and Outcomes of Access-Related Radial Artery Pseudoaneurysms: A Single-Center, Retrospective Cohort Study

<h2>Abstract</h2><h3>Background</h3> Radial artery pseudoaneurysm (RAP) is a rare complication of procedural radial access. There is a paucity of data regarding clinical presentation, characteristics, and management. <h3>Methods</h3> We identified patients with RAP by querying our center's electronic medical records. A manual chart review was performed, and a descriptive analysis was conducted. <h3>Results</h3> We identified 35 patients with RAP (mean age, 68.3 years; 62.9% women). Of these, 71.4 % of pseudoaneurysms were caused by arterial access for coronary procedures. Sixty percent were on anticoagulation. The most common symptoms were swelling (88.6%) and pain (45.7%). The median time from procedure to diagnosis was 13 days (IQR, 1-33.5 days), and the median time from procedure to symptom onset was 1 day (IQR, 0-8.5 days). Initial treatment modality was mechanical compression in 19 patients (54.3%). Of those who underwent compression, the RAP thrombosed in 9 patients (47.4%) and failed in 10 patients (52.6%) who then underwent successful surgical repair. Those with RAP resolution with compression had a shorter time to ultrasound diagnosis (1 vs 6.5 days) and smaller size (1.6 vs 2.4 cm). Surgery was successful in all but 1 patient. <h3>Conclusion</h3> Study findings show that RAPs often present several days after the index procedure, although symptoms occur much earlier. The RAPs occur disproportionately in women and those on anticoagulation. Compression is successful in only half the patients. Earlier presentation and smaller size predict success. Surgery is almost universally successful, and thrombin injection is rarely used. Our results suggest a need for prospective studies to assess strategies for earlier identification of RAP.