Radiyal Arteriyel Girişimin Nadir Bir Komplikasyonu: Radiyal Psödoanevrizma ve Tedavi Seçenekleri
Özet
Transradiyal girişim (TRG), transfemoral yaklaşıma kıyasla düşük kanama riski, vasküler komplikasyonların azlığı ve erken taburculuk avantajları nedeniyle günümüzde koroner anjiyografide ilk seçenek haline gelmiştir. Ancak TRG kullanımı arttıkça, %0.1'den az sıklıkla görülen radiyal psödoanevrizma gibi nadir komplikasyonlarla karşılaşma oranı da artmaktadır. İleri yaş, antikoagülan kullanımı, geniş kateter seçimi ve yetersiz bası uygulaması bu durum için başlıca risk faktörleridir. Sunulan vakada, mekanik aort kapağı nedeniyle varfarin kullanan 63 yaşındaki bir erkek hastada, sol radiyal arter yoluyla yapılan koroner anjiyografiden 1.5 ay sonra sol el bileğinde pulsatil şişlik saptanmıştır. Yapılan renkli Doppler ultrasonografide radiyal arter ile ilişkili dar boyunlu bir psödoanevrizma izlenmiştir. Baskılı pansumana yanıt vermeyen ve uzun süredir mevcut olan bu lezyon, antikoagülan tedavi altındaki hastada kompresyon tedavisinin başarı şansının düşük olması sebebiyle kalp ve damar cerrahisine sevk edilmiştir. Hasta, cerrahi tamir operasyonu ile başarıyla tedavi edilmiş; kontrol ultrasonografisinde tamirin başarılı olduğu ve ek komplikasyon gelişmediği görülmüştür. Sonuç olarak, TRG sonrası gelişen psödoanevrizmaların tanı ve yönetiminde renkli Doppler ultrasonografi kritik rol oynamakta ve konservatif yöntemlere yanıtsız büyük vakalarda cerrahi müdahale altın standart olarak önemini korumaktadır.
Transradial approach (TRA) has become the primary choice in coronary angiography due to lower bleeding risks, fewer vascular complications, and early discharge benefits compared to the transfemoral route. However, as the use of TRA increases, rare complications such as radial pseudoaneurysm, which occurs in less than 0.1% of cases, are observed more frequently. Advanced age, anticoagulant use, large sheath size, and inadequate compression are the main risk factors. In the presented case, a 63-year-old male patient using warfarin for a mechanical aortic valve developed a pulsatile swelling in his left wrist 1.5 months after a coronary angiography via the left radial artery. Color Doppler ultrasonography revealed a narrow-necked pseudoaneurysm associated with the radial artery. Because this long-standing lesion did not respond to compression therapy and the success rate of compression is low in patients under anticoagulation, he was referred to cardiovascular surgery. The patient was successfully treated with surgical repair; follow-up ultrasonography confirmed successful treatment without additional complications. In conclusion, color Doppler ultrasonography plays a critical role in diagnosing and managing post-TRA pseudoaneurysms, and surgical intervention remains the gold standard for large cases unresponsive to conservative methods.
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