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Insight

Non-Invasive Management of Radial Artery Pseudoaneurysm

Aren Mnatzakanian/LinkedIn

Oct 2, 2025, 07:31

Non-Invasive Management of Radial Artery Pseudoaneurysm

Aren Mnatzakanian, Researcher at Breast Imaging Research Consortium, shared a post on LinkedIn:

“In our latest “Lessons in IR” paper published in JVIR, we described the non-invasive management of a rare iatrogenic complication of transradial access, radial artery pseudoaneurysm (RA-PSA). We provide the following insights into how to anticipate, prevent and manage this complication.

Case
The day after successful rental artery stenting via left transradial access, our patient developed a pulsatile mass at the puncture site. Doppler US showed a 9 × 7–mm saccular outpouching of the superficial radial artery wall (arrow, Fig 1a) with turbulent flow through a narrow 2-mm neck (arrow, Fig 1b), consistent with pseudoaneurysm. To attempt non-invasive management, the skin overlying the lesion was marked under US guidance. A TR Band was applied directly over the pseudoaneurysm and inflated with 12 mL of air (nonocclusively) for 48 hours, allowing sufficient time for immobilization and spontaneous thrombosis. Follow-up Doppler US confirmed complete thrombosis with patent parent artery (Fig 1c). Recovery was uneventful.

Preparation

Patient risk factors for radial artery pseudoaneurysm (RA-PSA) include older age, vessel calcification, anticoagulant/antiplatelet use, and coagulopathy.
Procedural risk factors include repeated punctures, catheter infection, larger sheath size, longer procedure, and incomplete hemostasis.
Identify high-risk patients as they may require prolonged compression and closer postprocedural monitoring.

Avoidance

Society of Interventional Radiology (SIR) Quality Improvement Standards report RA-PSA rate of 0.5% (0–0.72%) with quality index threshold 1.2%; higher rates require audit.
Perform the Barbeau or modified Allen test before the procedure to assess collateral hand circulation.
Ensure artery-sheath compatibility with preprocedural US (anteroposterior diameter, inner-to-inner wall).
Monitor postprocedural radial pulse, plethysmography, pain, weakness, discoloration, reduced temperature, and sensory deficits in the hand/fingers.

Management

Treatment of pseudoaneurysms is guided by size, location, aneurysm neck and symptoms, distal circulation, and presence of thrombus.
Nonsurgical options include manual or US-guided probe compression, nonocclusive hemostatic cuffs (eg, TR Bands), and image-guided thrombin injection.
Titrate volume of TR Band after achieving occlusive hemostasis by withdrawing 1 mL/s of air until pulsatile bleeding is observed at the access site, followed by injection of 1–2 mL until bleeding stops.
Surgical repair is indicated for large or rapidly expanding RA-PSA, unsuccessful conservative management, infection, distal hand ischemia, and compressive neuropathy of the radial or median nerves.”

Pseudoaneurysm

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Aren Mnatzakanian Case Health Hematologist Hemostasis Today Lessons in IR Medicine RA-PSA Radial Artery Pseudoaneurysm thrombosis Treatment of Pseudoaneurysm

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