Surgical Repair of a Snuffbox Radial Artery Pseudoaneurysm

A rare case of a snuffbox radial artery pseudoaneurysm treated surgically is presented. Given the broad base, short neck and relatively large size of the pseudoaneurysm sac, compression techniques and intra-sac thrombin injection were deemed inappropriate, as they have been associated with ischemic complications within the sparse literature. Open surgical resection of the pseudoaneurysm with primary end-to-end repair of the radial artery was performed. Technical success was achieved with restoration of flow through the radial artery and the palmar arch with maintained patency and alleviation of symptoms immediately post-operative and at 3-months follow-up. Naiem Nassiri*, Samuel Kogan, Huong Truong, KJ Nagarsheth, Randy Shafritz and Saum Rahimi Department of Surgery, Rutgers Robert Wood Johnson Medical School, USA Naiem Nassiri, et al., Clinics in Surgery Vascular Surgery Remedy Publications LLC., | http://clinicsinsurgery.com/ 2016 | Volume 1 | Article 1154 2 Operative technique Under tourniquet exsanguination, a 5cm incision was made over the course of the pseudoaneurysm within the anatomical snuffbox. Using extensive sharp dissection, the pseudoaneurysm was dissected out circumferentially, as were the proximal and distal segments of the radial artery (Figure 3a). Once adequate lengths of the artery proximal and distal to the pseudoaneurysm was dissected and mobilized, the tourniquet was let down and the patient was systemically heparinized. Proximal and distal control was obtained and the pseudoaneurysm sac was incised, followed by suction of partially thrombosed contents (Figure 3b). Given the broad base of the pseudoaneurysm along the anterior wall of the radial artery, primary repair was not possible. Therefore, the pseudoaneurysm was resected and a spatulated, end-to-end anastomosis of the radial artery was performed using running 7-0 prolene sutures (Figure 3c). There was excellent re-establishment of flow within the radial artery confirmed by manual pulse palpation and Doppler interrogation. There were no perioperative complications. The patient was maintained in a gutter splint for 2 weeks post-op. Final pathology evaluation confirmed the presence of a partially thrombosed arterial pseudoaneurysm.