Distal arteriovenous fistula formation after percutaneous coronary intervention: An old complication of a new access site

Abstract

Dorsal or distal transradial artery access has recently gained popularity due to several perceived benefits that include favorable ergonomics, the potential for rapid hemostasis and lower rates of vascular complications. Still, no vascular access site is free of complications and reports of hematoma and pseudoaneurysm formation related to distal radial artery access have been reported in the literature. We present a case of a 71‐year‐old male who developed an arteriovenous fistula (AVF) involving the distal left radial artery following repeated access of the artery. This rare complication is likely avoidable with a comprehensive understanding of the surrounding anatomy and proper procedural technique, including the routine use of ultrasound for access.

Radial arteriovenous fistula complicated with ischemic steal syndrome after transradial cardiac catheterization: a case report and literature review

“…Nevertheless, Multiple sequelae encountered with TRA such as radial artery occlusion, hematomas, pseudoaneurysm and AVF, although less frequent, do occur [ 7 ]. The characteristics of previous radial AVF cases relative to catheter-based procedures have been reviewed [ 1 , 3 , 5 , 8 – 21 ]. The clinical manifestations of AVFs are mainly related to venous dilation as the arterial blood bypasses the tissues and capillaries, returning directly to veins [ 8 ].…”

“…Pain 2. Paresthesias and thrill 2 months later Doppler ultrasound Surgery Good Shah et al [ 3 ] 71/M 1. Dilated veins 2.…”

“…In the previous cases, nearly half of the compression therapy had failed, and surgery or endovascular treatment was eventually employed. In particular, the successful cases were treated at the early stage of the disease (about 1 month), while failed cases were diagnosed late (almost 1 year) [ 3 , 9 , 14 , 16 , 19 , 21 ]. Taking this into account, we believed that compression therapy could work as intended, but care must be taken of the adaptive time.…”

“…Depending on their location and etiology, AVFs can exhibit different presentations. Generally speaking, the fistula of the radial artery has fewer shunts, so it is not prone to develop clinical signs of hemodynamic significance compared with the femoral AVF [ 3 ]. Patients with AVF typically present with a palpable thrill, bruit, or pulsatile mass.…”

Application of ultrasound in cardiovascular intervention via the distal radial artery approach: New wine in old bottles?

“…However, the absence of a blood flow signal in the occluded radial artery can be observed by ultrasound (Figure 5), which can greatly reduce the rate of underdiagnosis of RAO (6,36). Complications such as distal radial artery occlusion, haematoma, bleeding, arteriovenous fistula, pseudoaneurysm, infection, and entrapment are equally common after coronary intervention via the dTRA (38,55,56). In recent years, the incidence of distal radial artery occlusion after dTRA intervention has been reported to range from 0.12 to 5.2% (28,(38)(39)(40)57).…”