IMAGES FOR SURGEONS

True radial artery aneurysm: A rare cause for finger ischaemia

A 60-year-old man presented to the emergency department with

48 h of pain in the right hand and fingers including the thumb.
Examination revealed dusky fingertips with a capillary refill time of
5 s. Both radial and ulnar pulses were present. The patient denied
any previous trauma or arterial punctures to the area. Allen’s test
suggested radial artery dominant supply.
Computed tomography angiography revealed a partially
thrombosed aneurysmal segment of radial artery at the wrist
(Fig. 1). Duplex ultrasound revealed a heavily calcified 9-mm radial
artery aneurysm (RAA) and a 60% ulnar artery stenosis at the
wrist.
Under regional anaesthetic, the patient underwent a right RAA
repair with ipsilateral reversed cephalic vein interposition graft. Fig. 2. Intraoperative photograph of the aneurysm at the wrist (white
dashed line, radial artery; white parenthesis (from left to right), vein,
extensor pollicis brevis tendon, abductor pollicis longus tendon and
branch of radial nerve).

Intraoperative findings were that of a 3.5-cm segment of aneurys-

mal radial artery at the anatomical snuffbox (Fig. 2). Proximally,
the aneurysmal segment was occluded with atherosclerotic plaque
and distally with fresh clot. The histological analysis of excised
length of radial artery revealed a true arterial aneurysm with florid
arterial calcification.
True aneurysms of the distal radial artery are a rare occurrence,
with fewer than 10 confirmed cases reported in the English
literature.1–9 Most radial and ulnar artery aneurysms are traumatic
or iatrogenic in origin (e.g., hypothenar hammer syndrome or post-
arterial puncture pseudoaneurysms). A PubMed database search
revealed only nine histologically confirmed cases of true degenera-
tive RAAs.1–9 True RAAs presenting with ischaemic symptoms are
exceedingly uncommon with only one previous case reported in the
literature.6
The patient has consented to the use of his images and case for
publication.

AUTHOR CONTRIBUTIONS
Jade Lau Young: Investigation; methodology; writing - original
draft; writing-review & editing. Sergei Tchijov: Supervision.

DATA AVAILABILITY STATEMENT

Fig. 1. Computed tomography angiography showing the aneurysmal seg-
ment of radial artery at the wrist. All data underlying this work are available as part of the article.

© 2021 Royal Australasian College of Surgeons. ANZ J Surg (2021)

2 Images for surgeons

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© 2021 Royal Australasian College of Surgeons.