Radial Arteriovenous Fistula After Cardiac Catheterization

Abstract

A 64-year-old man underwent successful salvage angioplasty on an occluded right coronary artery after a failed thrombolysis for an acute inferior myocardial infarction. A second successful stenting procedure was performed 1 week later with Taxus drug-eluting stents (Boston Scientific) on further significant disease in the left mainstem and proximal left anterior descending artery. Both procedures were performed via the right radial approach with a 6F Cook sheath (William Cook Europe). The patient presented 5 weeks later complaining of dilated superficial veins over the right forearm (Figure 1), with an easily palpable thrill at the right radial puncture site. Subsequent Doppler ultrasound imaging demonstrated a radial arteriovenous fistula (Figure 2). Arteriovenous fistula is a well-recognized complication after cardiac catheterization via the femoral or brachial approach, but it has not been reported in previously published series of radial catheter-based procedures. This patient was referred for surgical ligation of the fistula, which was delayed until he completed a 6-month course of clopidogrel. Figure 1. Dilated superficial veins on the volar surface of the right forearm. A prominent thrill was detected over the radial artery puncture site.Figure 2. Doppler ultrasound confirmed the presence of an arteriovenous fistula over the radial artery puncture site.

Arteriovenous fistula as a complication of transradial coronary angiography: a case report

“…Fourth, conservative therapy, the approach taken in our patient, is a viable option, given the benign natural history of AVF and the fact most seal spontaneously. This case challenges the dogma that AVF caused by use of the TRA approach needs to be addressed surgically, as was the case in all the previous publications describing this complication [13-15]. It is our opinion that as long as radial AVF is of no inconvenience to the patient, is not enlarging and does not cause neurovascular compromise and/or cardiac insufficiency, it should be treated conservatively without any intervention.…”

“…However, AVF in the arm is very rare and has been reported very infrequently [13-15]. In the RIVAL study, 5 (0.14%) of the 3514 patients undergoing transfemoral PCI had AVF, whereas none of the 3507 patients in the TRA arm were reported to have AVF.…”

“…First, surgical repair, the approach taken for all the reported cases of radial AVF undergoing coronary angiography [13-15], has been advocated as the intervention of choice. This is an invasive option with its own reported rates of peri-operative morbidity and mortality [17].…”

Usefulness of continuous compression using TR Band™ for radial arteriovenous fistula following trans-radial intervention

“…We identified 8 case reports [5][6][7][8][9][10] of iatrogenic radial AVF that provided detailed clinical outcomes (Table 1): 5 of these patients [5][6][7] underwent operation, while 2 [8,9] received endovascular treatment (such as implantation of a covered stent or balloon-assisted percutaneous embolization), and 1 patient [10] was conservatively observed. We assumed that the TR Band TM used to treat our patient completely cut off the blood stream from the radial artery to the cephalic vein, leading to AVF occlusion.…”

A Rare Case of Radial Arteriovenous Fistula After Coronary Angiography

“…Only three cases of AVF have been reported in previously published studies of radial catheter-based procedures (Table 1). 6)7) We report here a rare case of AVF, which developed after coronary angiography perfomed using the transradial approach.…”