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Objective
True aneurysms of the radial artery are extremely rare with only a few cases reported in the literature. Most cases of radial artery aneurysm are attributed to iatrogenic trauma, connective tissue disorders, occupational injury (Tailor’s Thumb), and infection. Proximal and distal ligation of the radial artery with excision of the aneurysmal segment has been the treatment of choice in previously documented case reports.
Methods
A 52-year old Caucasian male with a past medical history of intravenous drug abuse presented with altered mental status and an intracerebral hemorrhage. Blood cultures on admission were positive for Enterococcus faecalis. A transesophageal echocardiogram demonstrated a 3mm vegetation on the aortic valve. He was started on ampicillin and ceftriaxone. Upon examination, the patient was noted to have a pulsatile mass along the anatomical snuffbox of his left wrist. The patient did not have any prior history of radial artery catheter placement. An ultrasound was obtained which demonstrated a 1.2cm X 1.4cm radial artery aneurysm.
Results
The patient was taken to the operating room for excision of the radial artery aneurysm. Prior to the procedure, an Allen’s test was performed confirming collateral blood flow to the hand. A longitudinal incision was made over the radial artery aneurysm. The radial artery was ligated proximally and distally. The aneurysmal segment was excised. Evaluation by Pathology revealed a true aneurysm of the radial artery with no microscopic evidence of infection or inflammation.
Conclusions
True aneurysms of the radial artery are rare. Management consisting of ligation and excision of the involved segment is a safe treatment option provided that the patient has good collateral blood flow to the hand.