Case Report
Vascular and Endovascular Surgery
Management of Unusual Proximal Radial
Artery Aneurysm
Luke Umana, MD1, Andi Peshkepija, MD1, Elliot J. Yee, BS1,
Jane Liao, BS1, Nick Donde, BS1, and Raghu Motaganahalli, MD1
Abstract
Distal upper extremity arterial aneurysms are rare with only a few case reports and small retrospective studies described. Most
aneurysms are secondary to trauma making idiopathic aneurysms an especially rare disease process. An 83-year-old male pre-
sented with a painful pulsatile mass that was confirmed with ultrasound and computed tomography angiogram as a 2.0  1.5 cm
radial artery aneurysm. He had successful aneurysm resection and primary repair. Histopathology confirmed a true aneurysm.
This case report demonstrates successful excision and repair of this rare pathology. This case is been reported more for its rarity
than complexity of the treatment.
Keywords
radial artery aneurysm, upper extremity aneurysm, arterial aneurysm
Case Report
Informed consent has been obtained from the patient (or
patient’s guardian) for publication of the case report and
accompanying images. An 83-year-old white male with no
prior vascular history presented to his local emergency depart-
ment with a painful mass on his right forearm. This small mass
was located on the flexor surface of his forearm just distal to his
elbow crease. He denied any recent trauma, intervention,
venous access, or instrumentation on the affected area. Duplex
ultrasound demonstrated a 2.0  1.5 cm radial artery aneurysm
(Figure 1A). Color Doppler and power Doppler studies also
confirmed presence of a radial artery aneurysm (Figure 1B and
C). A computed tomography angiogram of the arm also rede-
monstrated the 2.0  1.5  0.8 cm radial artery aneurysm
approximately 8 cm from the brachial artery branch point
(Figure 2A and B). He was referred to our outpatient clinic for
consideration of resection.
Preoperative ultrasound confirmed the aneurysm just dis-
tal to the takeoff of the radial artery. The patient was
prepped in a fashion allowing for saphenous venous harvest-
ing for interposition grafting. An incision was then made
over the volar aspect of the forearm overlying the aneurysm.
Dissection was performed to isolate the entire aneurysm by
ligating the vena comitantes and also to achieve proximal
and distal control. The aneurysm was pulsatile and saccular
in nature (Figure 3A). After the excision of the aneurysm
(Figure 3B), additional dissection of the radial artery was
performed both distally and proximally to achieve sufficient
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mobilization for primary anastomosis. A tension-free anasto-
mosis was performed using a spatulated technique in an end–
end fashion with 7-0 Prolene (Figure 3C). Distal flow in the
radial artery was confirmed with palpation, and the fascia
was reapproximated and skin closed with 4-0 Monocryl. The
patient tolerated the procedure well. He was observed for
24 hours and was discharged with no complications. Histo-
pathology evaluation revealed a specimen with a central
cavity measuring 1.2 cm filled with coagulated blood and
wall thickness varying from 0.1 to 0.4 mm in a laminated
fashion consistent with a radial artery aneurysm (Figure 4A
and B). At the end of 6 months, patient had a patent radial
artery bypass on duplex examination with no concerns
with repair.
Discussion
Upper extremity aneurysms remain a rare entity1,2 with only
a handful of documented cases in the literature, accounting
for approximately 1% of all vascular aneurysms. True radial
artery aneurysms are very unusual with those reported in
1
Division of Vascular Surgery, Indiana University School of Medicine, Indiana-
polis, IN, USA
Corresponding Author:
Raghu Motaganahalli, Department of Vascular Surgery, Indiana University
School of Medicine, 1801 N. Senate Blvd. Ste 3500 Indianapolis, IN 46202, USA.
Email: rmotagan@iupui.edu
412
Figure 1. Preoperative radiographic images depicting the radial artery
aneurysm. A, Cross-sectional ultrasound image of the aneurysm. The
aneurysm is demarcated with white markers measuring 2.0  1.5 cm.
B and C, Representative color Doppler and power Doppler images of
the radial artery aneurysm.
distal radial artery, in anatomical snuff box.3-8 The majority
of these upper extremity aneurysms originate from the
subclavian artery making distal aneurysms such as radial
or ulnar much more rare. Trauma to the arterial system,
mostly iatrogenic, is the most common cause of pseudoa-
neurysm formation. This is usually from intravenous cannu-
lation with arterial injury, inadequate compression after
invasive blood pressure monitoring, catheter removal, arter-
ial dissection proximally, or associated with Behcet
disease.9
Vascular and Endovascular Surgery 53(5)
Figure 2. Preoperative coronal sectional images (A and B) from CT
angiography. The radial artery aneurysm is visible (arrows) as the
radiopaque mass just deep the subcutaneous tissue on the flexor
surface of the arm. CT indicates computed tomography.
Surgical management should be considered for sympto-
matic aneurysms to avoid sequelae such as embolization, rup-
ture, thrombosis, or increased pain due to nerve compression.
Observation is another viable option, especially since more
distal aneurysms are less susceptible to rupture.10 Given the
low comorbidity associated with surgical repair, definitive
surgical treatment should be considered.
The radial artery aneurysm in this case can be considered
truly idiopathic as there was no recent of trauma of any sort,
instrumentation, or autoimmune pathology. Most case
reports published approached this disease process with either
ligation or excision or excision with repair.11 Both primary
anastomosis and repair with interposition grafting have been
described. Our preoperative workup included imaging which
demonstrated adequate flow through the ulnar artery which
would suffice for collateral perfusion, but an intraoperative
tension-free anastomosis was achieved without difficulty.
Simple ligation has been described as an adequate option
if preoperative Allen test suggests adequate distal limb per-
fusion, but we suggest revascularization if technically
feasible.
Conclusion
Proximal radial artery aneurysms are rare. Case report pre-
sented here adds to the existing information about this unusual
pathology that can be repaired with primary repair and
excision.
Umana et al 413

Figure 3. A, Intraoperative image of the radial artery aneurysm after dissection from surrounding tissues. It is saccular in nature and was visibly
pulsatile. B, The aneurysm was passed off the field and was sent to pathology for examination, measuring approximately 2  1.5 cm. C, Tension-
free anastomosis performed with 7-0 Prolene sutures after the aneurysm was successfully resected.

Figure 4. Cross-sectional histopathology photomicrograph of the radial artery aneurysm. A, Low power view of dilated vessel. Calcification
present in lower left corner (purple). B, Higher power view of vessel wall. Some residual smooth muscle of the vessel wall (central pink band).

Declaration of Conflicting Interests References

The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
ORCID iD
Raghu Motaganahalli https://orcid.org/0000-0002-9399-2832
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