SURGICAL REPAIR OF IDIOPATHIC MID-FOREARM RADIAL ARTERY ANEURYSM USING A REVERSED GREATER SAPHENOUS VEIN INTERPOSITION GRAFT

Objectives: Idiopathic, non-traumatic, radial artery aneurysms are rare in medical literature. There are currently only 22 published case reports of non-traumatic radial artery aneurysms published (Chee et al, 2020). We describe the use of a greater saphenous vein (GSV) interposition graft for repair of an idiopathic mid-forearm radial artery aneurysm.

Methods: The patient is a 56 year old with past medical history of hypothyroidism and hypertension who presented to the vascular surgery clinic following a referral from orthopedic surgery. He underwent a carpal tunnel syndrome workup with the orthopedic surgeon due to a 15-month history of chronic, generalized left-hand pain and atrophy of the thenar eminence in his left hand. Electromyography (EMG) showed severe neuropathy of the left hand and moderately severe neuropathy of the right. MRI revealed an unlikely finding of an ovoid T2 hyperintense lesion adjacent to the distal radius. This corresponded to a physical exam finding of a pulsatile mass 3-4 cm proximal to the wrist. To further investigate, he underwent a duplex ultrasound of the extremity which confirmed a 1.01 cm x 1.31 cm left radial artery aneurysm, 3 mm proximal to the wrist. There were no clinical signs of ischemia and no splinter hemorrhages evident on exam. No other aneurysms were present on exam.

Results: The patient underwent excision of the radial artery aneurysm and repair using a reversed GSV interposition graft. The GSV was chosen as a conduit due to the large size of the radial artery. The patient had a palpable radial pulse and restoration of flow to the left had at the end of the case. He went home on day of surgery.

Conclusion: Idiopathic radial artery aneurysms are rare in medical literature. Most radial artery aneurysms and pseudoaneurysms are secondary to traumatic mechanisms including iatrogenic arterial cannulation. Other causes include connective tissue disorders, infection, vascular tumors, and fibromuscular dysplasia. The most common locations published in literature include the anatomic snuffbox, wrist, and proximal radial artery. Options for repair following excision of the aneurysm include ligation of the radial artery, use of the cephalic vein or GSV as an interposition graft, or use of synthetic graft. In this patient, the more proximal location of the aneurysm made ligation a less appealing option. Additionally, the GSV was chosen due to the larger size of the radial artery at this location. Future surveillance with noninvasive vascular testing will be used to monitor the patency of the GSV graft.