Sub-2 mm Radial Arterial Access for Endovascular Embolization of an Idiopathic Intramammary Pseudoaneurysm: A Case Report

TL;DR

A rare case of a spontaneous intramammary pseudoaneurysm was successfully treated using a small radial artery access in a patient from the Indian subcontinent.

Contribution

Demonstrates the safe use of sub-2 mm radial arteries for endovascular embolization in treating rare intramammary pseudoaneurysms.

Findings

A sub-2 mm radial artery was successfully used for endovascular treatment of an intramammary pseudoaneurysm.

Intraprocedural nitroglycerine use prevented radial artery spasm and postprocedural thrombosis.

Sub-2 mm radial access is a viable option for subclavian or visceral arterial pathologies.

Abstract

Radial arterial access is a relatively uncommon vascular access site. In the Indian subcontinent, the radial artery diameters are usually sub-2 mm. Here, we present a case of a spontaneous intramammary pseudoaneurysm (Im-PSA) arising from the left internal mammary artery, which was endovascularly treated via a sub-2 mm left radial access. Intermittent 50 µg nitroglycerine (NTG) was instilled every 15-20 minutes via the sheath, intraprocedurally, and a bolus of 100 µg NTG was instilled before a 1:1 sheath-catheter flush configuration. There was no intraprocedural radial artery spasm or postprocedural thrombosis. The preprocedural and intraprocedural steps have been outlined for ease of radial access in such a subset of patients. Im-PSAs are common after percutaneous breast biopsies, and spontaneous Im-PSAs are rare. We recommend that radial access via sub-2 mm radial arteries can be safely and successfully performed for subclavian or visceral arterial pathologies.

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