 true radial artery aneurysms are extremely rare , with no documented prevalence in the medical literature . in 1966 , the first recognition of this condition was introduced by thorrens , and since then some reports have been published .
this paper describes a case of true radial artery aneurysm in a 65-year - old woman , and presents the clinical presentation , aetiologies , and diagnostic and therapeutic modalities .
a 65-year - old woman presented to the outpatient clinic with a pulsatile mass at her right wrist .
the patient denied history of trauma , surgeries or recurrent punctures , and there was no family history of aneurysms . upon physical examination , a mass of 2-by-3 cm found at the anatomical snuffbox area of the right hand , with no visible scars ( fig .  1 ) .
later , ct angiography detected a local dilation at the distal part of the right radial artery ( figs  2 and 3 ) .
complete body scan showed another aneurysm at the right common iliac artery measured 3-by-2.8 cm for which the patient was referred to a higher centre for possible endo - vascular intervention as it is not available in our hospital . 

figure  1:photo of the right hand of the patient shows a bulge at the snuffbox area . 

figure  2:transverse section of ct angiogram shows radial artery aneurysm at right hand ( arrow ) . 

figure  3:reconstructed three - dimensional image shows radial artery saccular aneurysm ( arrow ) .
photo of the right hand of the patient shows a bulge at the snuffbox area .
transverse section of ct angiogram shows radial artery aneurysm at right hand ( arrow ) .
reconstructed three - dimensional image shows radial artery saccular aneurysm ( arrow ) . under local anaesthesia , the aneurysm site was incised .
a saccular aneurysm of 2-by-1.5 cm appeared at the distal part of the radial artery . using vessel loops ,
a doppler examination was conducted and indicated positive signals over the thumb and digital arteries .
later , the histopathology report showed a dilated arterial sac with a complete fibromuscular wall and an organized thrombus attached to its lumen ( fig .  5 ) . 

figure  4:the aneurysm with the radial artery controlled proximally and distally . 
 figure  5:microscopic view of the aneurysmal wall shows the muscular layer .
upper extremity arterial aneurysms are rare in surgical practice . ogeng'o et al . found that the prevalence of radial artery aneurysms is 2.9% of all aneurysms affect the upper limbs .
many cases have been reported after thorrens , the majority reported traumatic pseudo - aneurysms and only few authors reported cases of  true idiopathic aneurysms .
a medline search was conducted using the terms  radial artery and  aneurysm and  radial artery and  pseudoaneurysm , and returned 68 and 46 articles , respectively , published until may 2013 . of these ,
radial artery cannulation , bone fractures , occupational injuries and traumas were the commonly reported causes .
up to 15 other cases were reported as aneurysms induced by systemic pathologies . among all 102 reported cases , only 8 cases were reported as idiopathic true radial artery aneurysms .
clinically , patients usually present with pulsatile swelling with or without pain which is usually due to the compression of the surrounding structures .
the aneurysm has the potential to cause ischaemia due to laminar emboli or thrombus formation .
moreover , traumatic rupture could occur due to the vulnerable location   nonetheless ; spontaneous rupture is always a possibility .
the diagnosis is initially clinical , but many imaging modalities could help in the diagnosis and in the management of such condition .
duplex ultrasonography can be used first to differentiate the aneurysm from other masses with the help of colour doppler ; it is inexpensive and carries no risk to patients .
ct angiography has the ability to delineate the aneurysms clearly , and it is ideal to scan the whole body to exclude the other aneurysms existence , although it carries the risk of contrast - induced nephropathy and is expensive .
magnetic resonance angiography ( mra ) is another choice , but its higher cost makes it unpopular .
in fact , the best treatment for radial artery aneurysms is still controversial ; however , the surgeon 's decision can be guided by taking some factors into consideration .
the critical question is : is it the radial or the ulnar artery that carries the majority of blood supply to the hand ?
currently there is no consensus about which non - invasive modality should be used to evaluate the circulation of the hand pre - operatively .
many options are available with variable sensitivity and specificity ; for instance , allen 's test , modified allen 's test , digital plethysmography , digital doppler waveforms , and pressures and duplex ultrasonography .
more reliable but invasive choices are available to assess the patency of the arteries and the development of the arterial arches , including ct angiography or conventional angiography .
patient symptoms and the presence of thrombosis , distal emboli or infections are also important factors to determine the mode of management .
technically , the management include the following choices : careful observation ; in case of small asymptomatic aneurysms , arterial ligation and aneurysm excision or arterial reconstruction ; whether by end 
end anastomosis or by vein graft in the case of aneurysmal dominant artery . in our patient , the decision to excise the aneurysm and ligate the artery was based on the results of ct angiography , modified allen 's test that clarified ulnar dominancy and the positive doppler signals over the dorsal digital artery of the thumb after radial artery clamping intra - operatively .
 true aneurysms of hand arteries are rare . 
 i present a case of a true saccular aneurysm of the distal radial artery in a 65-year - old woman with no history of trauma . 
 the ct angiography , intraoperative features , operative procedure , histopathological examination and literature review are presented and discussed . 
INTRODUCTION
CASE REPORT
DISCUSSION