Delayed Presentation of Splenic Artery Aneurysm Rupture Treated Transradially
Sean P. Wengerter, MD, William Beckerman, Ajit Rao, MD, Micheal L. Marin, Peter L. Faries.
Mount Sinai, NY, NY, USA.
Objective(s): To present a case report of a delayed presentation after splenic artery rupture that was repaired with coil embolization via transradial artery access. To review transradial access techniques.
Methods: Transradial access was achieved under ultrasound guidance with a 21 G, 35 mm micro-puncture needle, a .018 wire and 6 French hydrophilic radial sheath. Prior to access the radial artery was assessed with the Barbeau test to confirm collateralization. Heparin (3000 units), verapamil (2.5 mg), and nitroglycerin (200 mcg) were administered intra-arterially. A 5 Fr 110 cm Sarah radial catheter and 260 Bentson wire were utilized to gain access to the infrarenal aorta. The sheath was exchanged for a 6 Fr 90 cm hydrophilic sheath. The celiac artery was cannulated with the 5 Fr 110 cm Sarah radial catheter and a 2.8 Fr 150 cm microcatheter system was utilized to access the splenic artery. The microcatheter was utilized to coil embolize the splenic aneurysm. A transradial band was utilized to administer non-occlusive pressure at the arteriotomy site after sheath removal.
Results: Successful embolization of the inflow, outflow and aneurysm sac was achieved from the left radial access site. The patient ambulated less than 1 hour after the procedure and was discharged on the morning of post-operative day one. The patient tolerated embolization well, with no flank pain or other sequelae. On one month follow up the patient was noted have a palpable left radial pulse and remained asymptomatic.
Conclusions: Transradial access for visceral interventions is safe and effective. Transradial access utilization should be utilized when possible due to increased patient satisfaction and decreased access site complications.
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