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      Radial artery pseudoaneurysm after transradial cardiac catheterization: A case presentation

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          Abstract

          Cardiac catheterization through the radial artery has reduced the percentage of complications seen previously in the femoral approach. Computed tomographic angiography is a noninvasive technique that can accurately diagnose pseudoaneurysms and other vascular pathologies.

          A 93-year-old female presented to the emergency department with pain and swelling of her right distal arm and wrist after a transradial cardiac catheterization procedure, as part of a transcatheter aortic valve replacement evaluation for severe aortic stenosis.

          Angiography is the standard diagnosing technique for aneurysms and pseudoaneurysms, but it is an invasive procedure. We show this case in order to highlight the importance of computed tomographic angiography as a noninvasive approach in diagnosing uncommon complications in the clinical setting.

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          Pseudoaneurysms and the role of minimally invasive techniques in their management.

          Pseudoaneurysms are common vascular abnormalities that represent a disruption in arterial wall continuity. Some complications associated with pseudoaneurysms develop unpredictably and carry high morbidity and mortality rates. The advent of new radiologic techniques with a greater sensitivity for asymptomatic disease has allowed more frequent diagnosis of pseudoaneurysms. Conventional angiography remains the standard of reference for diagnosis but is an invasive procedure, and noninvasive diagnostic modalities (eg, ultrasonography [US], computed tomographic angiography, magnetic resonance angiography) should be included in the initial work-up if possible. A complete work-up will help in determining the cause, location, morphologic features, rupture risk, and clinical setting of the pseudoaneurysm; identifying any patient comorbidities; and evaluating surrounding structures and relevant vascular anatomy, information that is essential for treatment planning. Therapeutic options have evolved in recent years from the traditional surgical option toward a less invasive approach and include radiologic procedures such as US-guided compression, US-guided percutaneous thrombin injection, and endovascular management (embolization, stent-graft placement). The use of noninvasive treatment has led to a marked decrease in the morbidity and mortality rates for pseudoaneurysms. Copyright RSNA, 2005.
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            Cinematic Rendering in CT: A Novel, Lifelike 3D Visualization Technique.

            The purpose of this article is to present an overview of cinematic rendering, illustrating its potential advantages and applications.
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              Transradial vs. Transfemoral Approach in Cardiac Catheterization: A Literature Review

              The main objective of this review paper is to study the comparison between transradial and transfemoral approach in catheterization. Transradial and transfemoral are two main approaches which are used as a diagnostic and therapeutic purpose in catheterization. The transradial approach in interventional cardiology is safe, effective, and feasible as compared to the transfemoral approach. The aim of this study is to compare pros and cons of transradial vs. transfemoral approach in catheterization. We conducted this systematic review on the role of transradial vs. transfemoral catheterization. The articles included real human data on interventional approaches. Reviews on these strategies were conducted in PubMed, medical literature analysis and retrieval system online (MEDLINE), Cochrane, Medscape and National Institute of Health. To maintain a high standard of review, studies published in all non-famous journals were excluded. Data collected from the studies have suggested that transradial approach has less bleeding complications, cost effective, decreased hospital mortality rate, and less access site complications as compared to transfemoral approach. However, longer procedural duration and radiation exposure are still concerns regarding transradial approach. The findings of the present study show that transradial approach in catheterization is safe, effective, and feasible as compared to the transfemoral approach. However, duration and radiation exposure are higher in the transradial access. Several studies suggest that the modern approach overweight in benefits with the comparison to the classical approach.
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                Author and article information

                Contributors
                Journal
                Radiol Case Rep
                Radiol Case Rep
                Radiology Case Reports
                Elsevier
                1930-0433
                07 September 2020
                November 2020
                07 September 2020
                : 15
                : 11
                : 2213-2216
                Affiliations
                [0001]The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, JHOC 3254, 601 North Caroline St, Baltimore 21287, MD, USA
                Author notes
                [* ]Corresponding author. efishman@ 123456jhmi.edu
                Article
                S1930-0433(20)30453-2
                10.1016/j.radcr.2020.08.063
                7490468
                cc71ae71-17e9-4fa3-a1b7-ea3bd4c89c84
                © 2020 Published by Elsevier Inc. on behalf of University of Washington.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 11 June 2020
                : 27 August 2020
                : 28 August 2020
                Categories
                Case Report

                cta,pseudoaneurysm,transradial catheterization,tavr evaluation,radial artery

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