Hybrid Repair of Large Radial Artery Pseudo-Aneurysm

A 56 year old female presented with a two month history of worsening left arm swelling after radiocephalic fistula cannulation. (A) Computed tomography angiography demonstrated a 6 cm pseudo-aneurysm (arrow) in the middle third of her left radial artery. Under general anaesthetic, ultrasound guided retrograde micropuncture of the left radial artery was performed at the wrist, with angiography confirming a large radial pseudo-aneurysm (B). A 4 × 40 mm balloon was inflated across the defect, the pseudoaneurysm entered, radial artery clamped, and defect primarily repaired with a 6-0 Prolene suture. Digital pressure was applied to the puncture site on sheath removal.Image 1