Repair of a symptomatic true radial artery aneurysm at the anatomic snuff box with interposition great saphenous vein graft

Abstract

Radial artery aneurysms are exceedingly rare, with only a few reported cases of surgical revascularization. We describe a 25-year-old man who presented with severe ischemia of the right hand secondary to an idiopathic true radial artery aneurysm at the anatomic snuff box. The patient had embolic occlusions in his hand and fingers that were treated with catheter-directed thrombolysis. During angiography, the blood supply to the affected hand was determined to be radial artery dominant, and therefore the aneurysm was resected and revascularized using an interposition great saphenous vein graft. The patient denied ischemic symptoms postoperatively, and duplex ultrasound examination at a 10-month follow-up showed patent interposition graft.

Keywords: Interposition; Ischemia; Peripheral radial aneurysm; Revascularization.

Fig 1

A, Duplex ultrasound image of the right anatomic snuff box, revealing a >6-mm fusiform radial artery aneurysm that is partially filled with mural thrombus. B, Color flow signal demonstrating patent radial artery at the anatomic snuff box.

Fig 2

A, Angiogram of right hand before lysis, demonstrating a small fusiform aneurysm (arrow) and a filling defect in the deep palmar arch over the level of the fourth metacarpal head, with complete occlusion of proper digital arteries D2 to D5. B, Angiogram of right hand after 48 hours of lysis therapy, revealing normal perfusion in the small finger and thumb, with improved segmental patency in the index, middle, and ring fingers.

Fig 3

A, Surgical exposure of the aneurysmal segment of the right radial artery at the anatomic snuff box. B, Interposition great saphenous vein graft across the resected aneurysmal segment.