CASE REPORT Year : 2022  |  Volume : 11  |  Issue : 3  |  Page : 86-88

Idiopathic radial artery true aneurysm: A rare entity

Ruhi Sharma1, Anshuman Darbari2, Rahul Sharma2, Ajay Kumar1
1 Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Department of Cardio-Thoracic and Vascular Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission20-Apr-2022Date of Decision16-Jul-2022Date of Acceptance21-Jul-2022Date of Web Publication11-Oct-2022

Correspondence Address:
Dr. Anshuman Darbari
Department of Cardio-Thoracic and Vascular Surgery, All India Institute of Medical Sciences, Rishikesh - 249 203, Uttarakhand
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/rcm.rcm_17_22

True idiopathic radial artery aneurysm is a rare entity. There are only a few cases reported in the literature. Asymptomatic radial arterial aneurysm in young patients is even rarer. Here, we present a successfully managed case report of a left radial artery aneurysm in a young female who presented to us with a painless, pulsatile swelling at the wrist.

Keywords: Aneurysm, false aneurysm, radial artery, wrist region

How to cite this article:
Sharma R, Darbari A, Sharma R, Kumar A. Idiopathic radial artery true aneurysm: A rare entity. Res Cardiovasc Med 2022;11:86-8
  Introduction 

An aneurysm is defined as the dilatation of an artery containing all the components of the arterial wall. An artery is said to be aneurysmal if its focal diameter is 1.5 times the normal size.[1] The average radial artery is 2–3 mm in diameter. Aneurysms develop as a result of a weakening of the arterial wall. Most of the radial artery aneurysms are iatrogenic pseudoaneurysm or false aneurysm that arises secondary to interventions carried out through the radial arterial route. Other causes of radial artery aneurysms include connective tissue disorders and vascular tumors.[2],[3] True idiopathic radial artery aneurysm is a rare entity. There are only a few cases of true radial artery aneurysms reported in the literature, the first being described by Thorrens et al. in 1966.[4] A rare case of true idiopathic distal radial artery aneurysm is presented here, which was successfully managed by surgical resection.

  Case Report 

A 22-year-old female presented with pulsatile swelling on her left wrist which was progressively increasing in size with mild pain. The patient is having right-hand dominance and gives a negative history of any trauma, surgery, drug use, or any intervention at this site. On examination, a pea-sized swelling with overlying normal skin without color changes was observed [Figure 1]. The swelling was pulsatile, but bruit was absent, and no other such swellings were present on full-body examination. The modified Allen test was positive for the left hand. Blood investigations ruled out any systemic inflammatory and autoimmune pathology. A duplex scan was done which showed a distal radial true aneurysm. Due to a rare diagnosis, we planned for further confirmatory investigation of a computerized tomogram angiogram (CTA). CTA revealed an 8 mm × 9 mm × 10 mm size aneurysm [Figure 2] arising from the distal portion of the radial artery with preserved palmar arch. Screening Doppler scan of upper limbs and lower limbs was done to exclude any other peripheral aneurysm. The patient was planned for surgery in view of the progressive increase in the size of the aneurysm, underlying tenderness, risk of thromboembolism, and risk of rupture of the aneurysm. The patient was taken up for surgical repair of an aneurysm under local anesthesia. Intraoperatively, distal and proximal radial artery controls were taken, and the aneurysm was excised, and end-to-end anastomosis of the arterial wall was done by Polypropylene 6–0 suture. The patient was discharged the next day with minimal swelling, no distal ischemia, no numbness, and without any discharge from the wound. Histopathology of the excised mass confirmed the diagnosis of a true aneurysm as it contains all three layers of vascular structure in the aneurysmal wall [Figure 3]. The outcome of this case was successful and, in a follow-up, visit after 2 months, the wound is entirely healthy without any distal neurovascular complication.

Figure 1: Swelling, marked by red color with overlying normal skin at the left wrist region

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Figure 2: Computerized tomographic angiogram image of an aneurysm arising from the distal portion of left radial artery (marked by red arrow)

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Figure 3: Histopathology image showing part of arterial wall with myxoid degeneration (H and E, ×10)

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  Discussion 

The pathogenesis of an aneurysm is the weakening of the arterial wall with focal dilation of all its components. Radial artery aneurysms are mostly traumatic or iatrogenic due to pseudoaneurysms.[5] Rarely, connective tissue disorders, arteriosclerosis, and infection have also been implicated in its etiopathogenesis.[6],[7] A true idiopathic radial artery aneurysm remains to be a rare entity, with a prevalence of only 2.9% among all upper limb aneurysms.[8]

The most common presentation of radial artery aneurysms is a painless pulsatile mass. Rarely, patients may present with pain and paresthesia if there is nearby nerve compression or rupture of the aneurysm. Thrombosis or distal embolization may lead to ischemia and related symptoms such as pallor, pain, or a cold finger. Radial artery aneurysms are presumed to be stable pathology with a low risk of embolization or rupture related to the size and location of the aneurysm, larger and proximal ones having a higher risk of complications.[9]

Ultrasound/duplex scan and CTA are the routinely used modalities for confirmation of the diagnosis of an aneurysm and further treatment plan. The current treatment guidelines are equivocal between surgical management and conservative management. The timing of surgery is dependent on the size, location, and presenting symptoms.[10] Endovascular techniques of stent-graft placement with occlusion of aneurysmal space with coils are described with limited success as thrombosis of stent-graft is noted in a significant number of cases. The role of endovascular management is limited to high-risk cases.[11]

  Conclusion 

Idiopathic radial artery aneurysm is a rarely encountered medical condition. Being mostly asymptomatic, it can easily be misdiagnosed as ganglion or lipoma, leading to incorrect management. The timely correct diagnosis by thorough clinical examination and radiological modalities is essential to prevent morbidities such as thromboembolic events, and sometimes, more severe complications such as ischemia leading to limb or finger loss.

Learning points

It is important to differentiate clinically between various distal forearm swellings. It is also important to differentiate between vascular pathologies from other connective tissue tumors, for example., ganglion and neurofibromasStandalone radial artery true aneurysms are rare. History of intervention through radial artery or iatrogenic causes mostly false aneurysmIt is important to differentiate between radial artery true aneurysms and pseudoaneurysmsIt is important to clinically examine regarding continuity of the palmer arch in these cases. Duplex scan and computed tomography angiography are important diagnostic tools for providing specific details.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

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  [Figure 1], [Figure 2], [Figure 3]