Pseudoaneurysm and Arteriovenous Fistula in the Radial Artery after Cardiac Catheterization: A Case Report

We report the case of a 71-year-old man who was experiencing a gradually worsening, dull pain and a cold sensation in his right hand. Three months earlier, he underwent a percutaneous coronary intervention for angina pectoris using a transradial approach in his right wrist and developed an arteriovenous fistula (AVF), a complication of percutaneous coronary intervention. Ultrasonography and computed tomography revealed a pseudoaneurysm and an AVF that were reducing the blood flow in his right hand. We observed that the pseudoaneurysm and the AVF were close to the bifurcation of the superficial palmar artery (SPA) and that the superficial palmar arch had radial artery superiority. Because we thought it was important to maintain the blood flow of the SPA branch, we excised the pseudoaneurysm, sutured the artery directly via microsurgery, and ligated the arteriovenous shunt. After the operation, the patient's symptoms were alleviated. Computed tomography showed that the blood flow in his right hand was improved and that his right SPA branch from the radial artery was directly fed to the index finger. Because the blood circulation in the hand is dual dominant but with many anatomical variations, we believe that it is important to preserve the blood flow of the SPA in postcatheterization pseudoaneurysm and AVF repair.