Robert Arnaud, T'kind Thibaud, Tawk Sammy, Honoré Patrick M, Bulpa Pierre
Intensive Care Unit, Mont-Godinne University Hospital CHU UCL Namur, Yvoir, Belgium.
Department of Radiology, Mont-Godinne University Hospital CHU UCL Namur, Yvoir, Belgium.
Am J Case Rep. 2025 Sep 19;26:e948021. doi: 10.12659/AJCR.948021.
BACKGROUND Anatomical variations of the radial artery are present in 10-20% of individuals. Such variations can impact management and clinical outcomes in vascular interventions, trauma, or surgeries. These abnormalities can pose diagnostic and therapeutic challenges, especially in cases of vascular trauma requiring prompt intervention. CASE REPORT We present the case of a 66-year-old woman with a history of bilateral lung transplantation, atrial fibrillation on anticoagulation, and prior breast cancer, who developed hemorrhagic shock following a fall. Initially presenting with neurological symptoms, her condition rapidly worsened, leading to unresponsiveness and coma. Initial imaging excluded intracranial pathology, but repeated imaging then revealed a large right chest wall hematoma with active bleeding from an aberrant radial artery originating from the axillary artery. The patient was managed with aggressive fluid resuscitation, blood transfusion, anticoagulation reversal, and ultimately interventional radiology. Radio-embolization allowed successful embolization of the bleeding vessel with preservation of hand perfusion. Further questioning revealed that the bleeding was caused by nursing management and by her complex medical history of steroid intake, lymph node dissection, and radiotherapy. CONCLUSIONS To the best of our knowledge this is the first description of hemorrhagic shock due to an aberrant radial artery originating from the axillary artery. The case underscores the diagnostic complexity of hemorrhagic shock in patients with abnormal vascular anatomy and significant comorbidities. It highlights the critical role of interventional radiology in managing such cases and the importance of multidisciplinary collaboration to ensure timely diagnosis, effective treatment, and prevention of ischemic complications. We discuss the current literature and management of complex upper-limb vascular trauma.
10%至20%的个体存在桡动脉解剖变异。这种变异会影响血管介入、创伤或手术中的处理及临床结果。这些异常情况会带来诊断和治疗挑战，尤其是在需要迅速干预的血管创伤病例中。
我们报告一例66岁女性病例，该患者有双侧肺移植史、抗凝治疗的心房颤动以及既往乳腺癌史，跌倒后发生失血性休克。最初表现为神经症状，病情迅速恶化，导致无反应和昏迷。初始影像学检查排除了颅内病变，但重复检查后发现右侧胸壁有巨大血肿，有一条起源于腋动脉的异常桡动脉活动性出血。患者接受了积极的液体复苏、输血、抗凝逆转治疗，最终接受了介入放射学治疗。放射性栓塞成功栓塞了出血血管，同时保留了手部血供。进一步询问发现出血是由护理管理以及她服用类固醇、淋巴结清扫和放疗的复杂病史所致。
据我们所知，这是首例因起源于腋动脉的异常桡动脉导致失血性休克的描述。该病例强调了血管解剖异常且合并严重疾病患者失血性休克的诊断复杂性。它凸显了介入放射学在处理此类病例中的关键作用以及多学科协作对于确保及时诊断、有效治疗和预防缺血性并发症的重要性。我们讨论了当前关于复杂上肢血管创伤的文献及处理方法。
