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.

中文翻译：

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经皮凝血酶注射微创介入桡动脉假性动脉瘤

一名患有严重二尖瓣关闭不全的 67 岁女性在通过右桡动脉 (RA) 进行二尖瓣手术前接受了冠状动脉造影术进行术前评估，显示冠状动脉正常。TR bandR 用于止血；然而，出现了一个小血肿，这促使 TR BandR 保持更长的时间。次日早晨，患者诉右前臂疼痛。检查显示访问站点上有一个搏动的肿块（在线补充材料，视频 S1）。动脉双工显示从右侧 RA 发出的大 RA 假性动脉瘤 (PSA)，尺寸为 26.5±14.4 mm（图 A 和 B，在线补充材料，视频 S2）。探索了治疗方案，包括手术修复。然而，患者选择了使用凝血酶注射到 PSA 中的经皮血管内介入 (PEI)。常规消毒后，用2%利多卡因麻醉右腕。在直接超声引导下，将 21 号脊椎穿刺针插入 PSA 腔并位于 PSA 颈部正上方。注射了六百 (600) 个单位的凝血酶，这成功地使 PSA 血栓脱落，没有出现不良并发症。超声双工确认完全停止流入 PSA（图 C 和 D，在线补充材料，视频 S3）。2 个月后在诊所重复动脉双工显示更小且完全血栓形成的 PSA（大小为 20.0 × 14.0 毫米），没有流入（图 E，在线补充材料，视频 S4）。与股动脉入路相比，桡动脉入路的血管并发症发生率较低（0.6% 对 1.5%）。假性动脉瘤罕见（发生率< 0.1%），