LAUSR

A 67-year-old woman with severe mitral regurgitation, underwent coronary angiography for pre-operative evaluation prior to mitral valve surgery via right radial artery (RA) which showed normal coronaries. TR bandR was applied for haemostasis; however, a small haematoma developed, and this prompted to keep the TR BandR for a longer period. The following morning, patient complained of right forearm pain. Exam revealed a pulsatile mass over the access site (Supplementary material online, Video S1). Arterial duplex showed a large RA pseudoaneurysm (PSA) emanating from the right RA and measuring 26.5 14.4 mm (Panel A and B, Supplementary material online, Video S2). Treatment options were explored including surgical repair. However, patient opted for percutaneous endovascular intervention (PEI) using thrombin injection into PSA. After usual sterilization, lidocaine 2% was used to anaesthetize the right carpus. Under direct ultrasound guidance, a 21-gauge spinal needle was inserted into the PSA cavity and positioned just above the neck of the PSA. Six hundred (600) units of thrombin was injected, and this successfully thrombosed-off the PSA with no untoward complications. Complete cessation of flow into the PSA was confirmed by ultrasound duplex (Panel C and D, Supplementary material online, Video S3). Repeated arterial duplex in the clinic 2 months later showed smaller, and completely thrombosed PSA (20.0 14.0 mm in size) with no flow into it (Panel E, Supplementary mate rial online, Video S4). Radial artery access has lower rate of vascular complications compared with femoral access (0.6% vs. 1.5%). Pseudoaneurysm is rare (incidence< 0.1%), but serious complication that should be managed surgically, or percutaneously using ultrasound-guided direct thrombin injection.