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Case Report - (2016) Volume 4, Issue 1

Bilateral Radial Artery Aneurysm: Case Report and Review of Literature

Thai H*, Vasyluk A and Rits Y
Vascular Surgery Fellow, Detroit Medical Center, Wayne State University, USA
*Corresponding Author: Thai H, Vascular Surgery Fellow, Detroit Medical Center, Wayne State University, USA, Tel: 206-484-3664 Email:


While arterial aneurysm in the lower extremities is common, upper extremity aneurysms are relatively infrequent. Radial artery aneurysms are sometimes associated with trauma and connective tissue disorders. Very few cases of radial artery aneurysm have been reported in the literature. We have encountered a case of bilateral radial artery aneurysms in a 61 year old male. A review of the English language literature was performed using Pub Med database, resulting in 31 reported cases of radial artery aneurysms, with most cases being either traumatic or idiopathic in etiology. Of these reports, bilateral aneurysms had clear etiologies, including Marfan’s vasculopathy, granulomatous arteritis, arteriosclerotic disease and intra-arterial drug injection. To our knowledge, this is the first reported case of primary bilateral radial artery aneurysms.

Keywords: Radial artery aneurysms, Peripheral aneurysms, Vasculitis

Case Report

A 61 year old left-hand dominant man with a history of frequent falls presented with bilateral hand pain and cellulitis. He has a history of falls in the weeks prior to presentation with redness, pain and swelling of his right wrist. Approximately a week later his left wrist and forearm also became swollen and erythematous. Physical exam revealed a moderately edematous left forearm with bilateral tender pulsatile masses at the wrists. Color flow duplex showed a maximum diameter of 1.3 and 1.5 cm of the left and right radial artery aneurysms, respectively, with intact palmar arches and bilateral radial dominance.

His past medical history includes hypertension and ischemic stroke two years ago. There was no indication from the history of connective tissue disease, and workup for vasculitis (sedimentation rate and C-reactive protein) was negative. A screening duplex of the popliteal arteries and CT of the chest and abdomen did not reveal other aneurysms.

Due to the size of the aneurysms and persistent symptoms operative management was discussed and the patient was taken to the operating room for subsequent aneurysm resection. The larger and more symptomatic aneurysm (right) side was resected first. Intraoperative findings showed significant inflammatory reaction and scar tissue encasing the aneurysm wall. There was an excellent doppler signal in the palmar and digits with the radial artery clamped. Thus we chose not to perform a bypass. A month later the patient returned for the left radial aneurysm resection. This aneurysm had septation and significant intramural thrombus. There was a radial artery dependent palmar circulation thus an interposition graft was performed with a reversed great saphenous vein. Patient experienced a full and uncomplicated recovery. Histological examination of the right aneurysm revealed fibromyxoid degeneration of the media with elastic tissue degeneration, while the left specimen showed increased perivascular inflammatory infiltrate but was not conclusive for vasculitis.


True aneurysms of the radial artery are rare, with most reported being false aneurysms, traumatic or iatrogenic in origin. Given normal inflammatory markers and recent history of trauma, these aneurysms are likely secondary to trauma provoked. A search of Englishlanguage literature reveals 29 cases of true radial artery aneurysms, mostly reported as single cases or case series. Tables 1 and 2 of these 4 was bilateral [1-4]. The most commonly etiologies were idiopathic and traumatic aneurysms, although it has been suggested that some of the cases of unknown etiology may be due to unrecalled trauma [3]. Other less common etiologies included mycotic aneurysms [5,6] atherosclerosis [7], NF-1 vasculopathy [8,9], vasculitis [3], and Marfan’s syndrome [1,10]. The reported cases show a male predominance, with a mean age of 57 years, and most typically occur in the distal part of the artery, around the wrist and “snuffbox”, where the artery is most superficial.

Author Sex Gender Size/Location Etiology Treatment
Yukios [1] 74 Female 9 mm, 5 mm, snufbox (bilateral) Marfans Ligation + excision (right)
Malt [2] 56 Male 2.0 cm,1.5 cm, wrist (bilateral) Arteriosclerotic Resection +anastomosis (right)
Leitner [3] 69 Female 1.5 cm, 2.0 cm wrist (bilateral) Granulomatous arteritis Ligation + excision (bilateral)
Coppola [4] 40 Male Wrist (bilateral) Intrarterial drug injection Ligation + excision (bilateral)
Shaabi [13] 65 Female 2 × 1.5 cm snuffbox Idiopathic/non-traumatic Ligation + excision
Luzzani [19] 63 Female 1.0 ×  1.1 cm snuffbox Idiopathic/non-traumatic Ligation + excision
Yaghoubian [26] 77 Male 1.0 ×  1.5 cm distal to snuffbox Idiopathic/non-traumatic Observation
Claudio [18] 47 Female 1.1 ×  1.0 cm wrist Idiopathic/non-traumatic Ligation + excision
Walton [25] 40 Male 1.5 cm snuffbox Idiopathic/non-traumatic Observation
Turner [14] 55 Male 2.0 cm distal RA (antecubital fossa) Idiopathic/non-traumatic Resection + anastomosis
Filis [20] 45 Male 2.0 × 3.0 cm snuffbox Idiopathic/non-traumatic Ligation + excision
Jedynak [15] 60 Male Snuffbox Idiopathic/non-traumatic Ligation + excision
Lee [24] 42 Male Left wrist Idiopathic/non-traumatic Resection + anastomosis
Behar [21] 62 Male 1.9 cm wrist Repetitive trauma Ligation + excision
Turowski [11] 70 Female 2 cm ×  7 cm wrist Traumatic Reconstruction with interposition vein graft
Kadowaki [5] 61 Male 2.0 × 1.5 cm snuffbox Mycotic Ligation + excision
Singh [9] 45 Male  Proximal radial artery NF-1 vasculopathy Ligation (no excision)
De Santis [8] 48 Female Multiple proximal + distal aneurysms NF-1 vasculopathy Ligation + excision
Thorrens [7] 60 Male 1.5 × 2.0 cm snuffbox Ateriosclerotic Resection + anastomosis
Goertz[10] 52 Male Snuffbox Marfans Ligation + excision

Table 1: Size location/Etiology with multiple patients.

Author Number pts Location Etiology Management
Gray [12] 2 Distral radial artery/wrist 1.Repetitive trauma
2. Idiopathic
1.Ligation + excision
2. Observation
Johnson [6] 4 U/K Mycotic Ligation + excision
Mayall [22] 1(41M) Distal radial artery/wrist Trauma Ligation + excision
Ho [17] 1 Wrist Blunt trauma Reconstruction w/ vein graft
Igari [16] 1 (72F) Snuffbox Idiopathic Ligation + excision
Poirier[23] 1(69M) Wrist Mycotic Ligation + excision

U/K = Unknown, N/A = Not Available

Table 2: Case series/reports with multiple patients.

Most cases present as an asymptomatic swelling [2,7,11,12] but can present with paraesthesias due to radial nerve compression [13], symptoms of embolization [14] or rupture [8]. Diagnosis is often made on physical exam which shows a pulsatile mass, as well as non-invasive imaging such as doppler ultrasound. While most such aneurysms are traumatic or idiopathic in nature, efforts should be made to evaluate for vasculitis or connective tissue disease where appropriate, as well as screening for other aneurysms. Radial artery aneurysms are rare and its management is not well described. Early intervention is recommended to prevent distal embolization as well as addressing pain and compressive symptoms [15].

The most commonly reported approach for radial artery aneurysms is ligation and excision [5,12,13,16-23] which appears to be the preferred in cases where the ulnar artery is the dominant arterial supply for the hand [13,15]. In cases where the ulnar collaterals are poor or there is radial dominant circulation, options include excision and anastomosis [3,7,24] or excision with interposition vein graft [11,17] if a tension free anastomosis could not be accomplished, as in our case. A few reports exist of long term follow up for radial artery reconstruction, ranging from 3 months to 5 years follow up, with most reporting no complications, including growth or recurrence of the aneurysm, but there is one published report of re-occurrence of aneurysm at 18 months [17]. We recommend pre-operative evaluation of palmar circulation with a digital doppler ultrasound.

In summary we recommend radial aneurysms to be repaired due to risks of embolization in additional to pain and compressive symptoms [25,26]. Preoperative laboratory testing should include a SED rate and CRP to exclude inflammatory components. Evaluation of the palmar circulation is necessary for operative planning. Treatment can include simple ligation, excision with primary anastomosis or with an interposition graft.


  1. Yukios U,Matsuno Y, Imaizumi M, Mori Y, Iwata H, et al. (2009) Bilateral radial artery aneurysms in the anatomical snuff box seen in marfan syndrome patient: case report and literature review. Ann Vasc Dis 2: 185-189.
  2. Malt S (1978) An arteriosclerotic aneurysm of the hand. Arch Surg 113: 762-763.
  3. Leitner DW, Ross JS, Neary JR (1985) Granulomatous radial arteritis with bilateral, nontraumatic, true arterial aneurysms within the anatomic snuffbox. J Hand Surg Am 10: 131-135.
  4. Coppola G,Amann-Vesti BR, Koppensteiner R (2003) Aneurysms of radial arteries and severe anemia. Vasa 32: 178.
  5. Kadowaki M, Hashimoto M, Nakashima M (2013) Radial mycotic aneurysm complicated with infective endocarditis caused by Streptococcus sanguinis. Intern Med 52:2361-2365.
  6. Johnson JR, Ledgerwood AM, Lucas CE (1983) Mycotic aneurysm. New concepts in therapy. Arch Surg 118: 577-582.
  7. Thorrens S, Trippel OH, Bergan JJ (1966) Arteriosclerotic aneurysms of the hand. Excision and restoration of continuity. Arch Surg 92: 937-939.
  8. De Santis F,Negri G, Martini G, Mazzoleni G (2013) Multiple aneurysms of the radial artery in a woman with neurofibromatosis type 1 presenting as aneurysm rupture. J VascSurg 58: 1394-1397.
  9. Singh S,Riaz M, Wilmshurst AD, Small JO (1998) Radial artery aneurysm in a case of neurofibromatosis. Br J PlastSurg 51: 564-565.
  10. Goertz O,Kapalschinski N, Stricker I, Hauser J (2010) [Aneurysm of the radial artery in a patient with marfan syndrome]. HandchirMikrochirPlastChir 42: 307-309.
  11. Turowski GA,Amjadi N, Sterling A, Thomson JG (1997) Aneurysm of the radial artery following blunt trauma to the wrist. Ann PlastSurg 38: 527-530.
  12. Gray RJ, Stone WM, Fowl RJ, Cherry KJ, Bower TC (1998) Management of true aneurysms distal to the axillary artery. J VascSurg 28: 606-610.
  13. Shaabi HI (2014) True idiopathic saccular aneurysm of the radial artery. J Surg Case Rep 2014.
  14. Turner WH, Turnbull AR (1988) True radial artery aneurysm. Br J Surg 75: 233.
  15. Jedynak J, Frydman G (2012) Idiopathic True Aneurysm of the Radial Artery: A Rare Entity. EJVES Extra 24: e21-e22.
  16. Igari K, Kudo T, Toyofuku T, Jibiki M, Inoue Y (2013) Surgical treatment of aneurysms in the upper limbs. Ann Vasc Dis 6:637-641.
  17. Ho PK, Weiland AJ, McClinton MA, Wilgis EF (1987) Aneurysms of the upper extremity. J Hand Surg Am 12: 39-46.
  18. Claudio NF, Ferreira MADA (2010) True aneurysm of the radial artery: a case report. J Vasc Bras 9: 239-240.
  19. Luzzani L, Bellosta R, Carugati C, Talarico M, Sarcina A (2006) Aneurysm of the radial artery in the anatomical snuff box. Eur J VascEndovascSurg 11: 94-96.
  20. Filis K, Arhontovassilis F, Theodorou D, Theodossiades G, Manouras A (2007) True radial artery aneurysm in a mild haemophilia A patient. Haemophilia 13: 440-442.
  21. Behar JM, Winston JS, Knowles J, Myint F (2007) Radial artery aneurysm resulting from repetitive occupational injury: Tailor's thumb. Eur J VascEndovascSurg 34: 299-301.
  22. Mayall JC,Mayall RC, Mayall AC, Mayall LC (1991) Peripheral aneurysms. IntAngiol 10: 141-145.
  23. Poirier RA, Stansel HC Jr (1972) Arterial aneurysms of the hand. Am J Surg 124: 72-74.
  24. Lee BY, Kim KK, Madden JL (1977) True aneurysm of the radial artery: report of a case with long-term follow-up. J Am GeriatrSoc 25: 376-378.
  25. Walton NP,Choudhary F (2002) Idiopathic radial artery aneurysm in the anatomical snuff box. ActaOrthopBelg 68: 292-294.
  26. Yaghoubian A, de Virgilio C (2006) Noniatrogenic aneurysm of the distal radial artery: a case report. Ann VascSurg 20: 784-786.
Citation: Thai H, Vasyluk A, Rits Y (2016) Bilateral Radial Artery Aneurysm: Case Report and Review of Literature. J Vasc Med Surg 4:247.

Copyright: © 2016 Thai H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.