A Case of Ultrasound-guided Thrombin Injection for Iatrogenic Pseudoaneurysm and Arteriovenous Fistula with the High Origin of the Radial Artery

Abstract

Endovascular treatment has recently become more common, and there may be an increase in the number of situations in which vascular surgery is required to deal with puncture complications. Here we present the case of an 80-year-old woman who underwent endovascular treatment at another hospital, then subsequently developed a brachial artery pseudoaneurysm and was referred to our hospital. Ultrasonography revealed a high origin of the radial artery from the axillary artery, and showed that the radial artery ran superficial to the brachial artery in the cubital fossa. It also revealed a pseudoaneurysm that was continuous with the brachial artery, as well as an arteriovenous fistula between the brachial artery and radial vein via the pseudoaneurysm. We selected ultrasound-guided thrombin injection (UGTI) as treatment. During the injection, we tried to prevent thrombus outflow from the artery to the vein by compressing the upper arm. The pseudoaneurysm became a thrombus, and both it and the arteriovenous fistula were treated completely. Caution should be exercised in the presence of vascular anomalies as they may cause unexpected complications. In carefully selected patients, UGTI is useful as a minimally invasive treatment for pseudoaneurysm even if it is associated with arteriovenous fistula.