1
|
Gu F, Yu J, Mi J. Radial arteriovenous fistula complicated with ischemic steal syndrome after transradial cardiac catheterization: a case report and literature review. BMC Surg 2022; 22:106. [PMID: 35313862 PMCID: PMC8939090 DOI: 10.1186/s12893-022-01562-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/15/2022] [Indexed: 11/27/2022] Open
Abstract
Background The radial arteriovenous fistula (AVF) is a rare complication occurring after transradial cardiac catheterization. Patients with AVF typically present with signs of venous dilation, such as swelling or palpable thrills. However, neurological complications secondary to radial AVFs are rare. This paper reported a rare case of ischemic steal syndrome that occurred 11 months after the transradial cardiac catheterization, most likely as a consequence of radial arteriovenous fistula. Case presentation This paper described a case of a 73-year-old female, who complained of right forearm swelling and radial 1–3 fingers numbness for several months after the catheterized stent surgery through radial approach. Upon Clinical examination, this patient presented with a slight bump and palpable thrill at the distal third of right forearm, and the sensory of radial 1–3 fingers and pinch force was compromised. The Ultrasonography and computed tomography angiography (CTA) of the upper extremity revealed AVF between the right radial artery and the adjacent vein. Microsurgery was performed successfully to ligate the fistula and reconstruct the radial artery. The numbness has gradually improved about 1 week after the surgery, with no recurred swelling. The two-point pinch force and digital sensitivity recovered at the 20-month follow-up. What’s more, due to the scarcity of cases, the optimal therapy for iatrogenic radial AVF is controversial. Accordingly, we provided a literature review of previous reports of catheter-related radial AVFs and proposed an algorithm to manage them. Conclusions We believe that once an AVF is diagnosed, early treatment options such as compression or surgery are necessary to relieve symptoms and prevent further complications. Otherwise, serious complications can occur, including the ischemic steal syndrome.
Collapse
Affiliation(s)
- Fengming Gu
- Medical College, Soochow University, Suzhou, Jiangsu, China
| | - Jiong Yu
- Department of Sports Medicine, Wuxi 9th People's Hospital Affiliated to Soochow University, 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Jingyi Mi
- Department of Sports Medicine, Wuxi 9th People's Hospital Affiliated to Soochow University, 999 Liangxi Road, Wuxi, 214062, Jiangsu, China.
| |
Collapse
|
2
|
Russu E, Mureşan AV, Kaller R, Coşarcă CM, Arbănaşi EM, Arbănaşi EM. Case Report: Gigantic Arteriovenous Femoral Fistula Following Cardiac Artery Catheterization. Front Surg 2022; 9:769302. [PMID: 35198595 PMCID: PMC8858822 DOI: 10.3389/fsurg.2022.769302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To present the case of a patient with a 9-mm iatrogenic fistula between a branch of the right profunda femoris artery, aneurysmally dilated at ~1.851cm, and the right femoral vein, successfully treated with open surgical ligation. Case Report A 70-years-old female was referred to the Vascular Surgery Clinic due to worsening cardiac failure symptoms during the previous year. The medical history included a diagnostic cardiac artery catheterism through a Seldinger technique one year and a half ago. A recent ultrasound described velocities characteristic for a high flow arteriovenous communication in the right groin. Two consecutive cardiology exams, performed at nine months from one another, showed a decrease of almost 21% in the ejection fraction of the left ventricle. An angiography was conducted with the hope of achieving effective percutaneous embolization. Unfortunately, that was not the case. An open repair was scheduled, as the option for a stent-graft deployment was overruled as being too risky, potentially closing several branches of the profunda femoris artery and not fully completing the orifice due to a complicated anatomical positioning. Under local anesthesia, an open ligation was performed in very hostile anatomical conditions. The patient had an uncomplicated evolution and was discharged on the third day, symptom-free. Conclusions Iatrogenic arteriovenous fistulas are rare. Clinical presentation diagnoses the case efficiently, vascular imaging being essential for surgical preparation. Though open repair is not the gold standard, there are cases not suitable for the endovascular approach. These patients are eligible for a surgical solution, not without technical challenges.
Collapse
Affiliation(s)
- Eliza Russu
- Clinic of Vascular Surgery, Emergency County Hospital, Târgu-Mureş, Romania
- First Department of Surgery, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu-Mureş, Romania
| | - Adrian Vasile Mureşan
- Clinic of Vascular Surgery, Emergency County Hospital, Târgu-Mureş, Romania
- First Department of Surgery, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu-Mureş, Romania
| | - Reka Kaller
- Clinic of Vascular Surgery, Emergency County Hospital, Târgu-Mureş, Romania
| | - Cătălin Mircea Coşarcă
- Clinic of Vascular Surgery, Emergency County Hospital, Târgu-Mureş, Romania
- Department of Anatomy, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu-Mureş, Romania
| | - Eliza-Mihaela Arbănaşi
- Department F2, Discipline of Pharmaceutical and Therapeutical Chemistry, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu-Mureş, Romania
| | - Emil-Marian Arbănaşi
- Clinic of Vascular Surgery, Emergency County Hospital, Târgu-Mureş, Romania
- *Correspondence: Emil-Marian Arbănaşi
| |
Collapse
|
3
|
Raelson C, Ahmed B. Prevention and Management of Radial Access Complications. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-0808-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
4
|
Aoun J, Hattar L, Dgayli K, Wong G, Bhat T. Update on complications and their management during transradial cardiac catheterization. Expert Rev Cardiovasc Ther 2020; 17:741-751. [PMID: 31608731 DOI: 10.1080/14779072.2019.1675510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Transradial artery access (TRA) was introduced in 1989 and has been universally used as an alternative approach to the traditional transfemoral access (TFA). Complications of TRA include asymptomatic and less likely symptomatic radial artery occlusion, nonocclusive radial artery injury, radial artery spasm, radial arterial perforation, radial artery pseudoaneurysm, arteriovenous fistula, granuloma formation, access-site bleeding, nerve damage, complex regional pain syndrome along with other rare complications.Areas covered: A literature search was performed using MedLine, PubMed, and Google Scholar (dating to 1 May 2019). Authors reviewed all articles related to transradial artery catheterization, its complications, as well as novel techniques for their management. The article provides insight on the incidence, risk factors, and prevention of such complications along with a description of usual and newer techniques to decrease morbidity.Expert opinion: With increasing experience, TRA complication rate is decreasing and new very uncommon complications are being described. A 'radial first' approach should be implemented in all catheterization laboratories and a physician's familiarity with minor and major complications is a must. Distal radial artery access through the snuff box might be the preferred site of accessing the radial artery and further studies will be needed to prove its superiority to the current access site.
Collapse
Affiliation(s)
- Joe Aoun
- Division of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, USA
| | - Laith Hattar
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Khabib Dgayli
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Gordon Wong
- Department of Medicine, UC Davis Medical Center, Sacramento, CA, USA
| | - Tariq Bhat
- Division of Cardiology, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| |
Collapse
|
5
|
Shah SR, Kiemeneij F, Khuddus MA. Distal arteriovenous fistula formation after percutaneous coronary intervention: An old complication of a new access site. Catheter Cardiovasc Interv 2020; 97:278-281. [DOI: 10.1002/ccd.28772] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 01/02/2020] [Accepted: 01/29/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Syed Raza Shah
- North Florida Regional Medical Center University of Central Florida Gainesville Florida
| | | | - Matheen A. Khuddus
- North Florida Regional Medical Center University of Central Florida Gainesville Florida
- The Cardiac and Vascular Institute Gainesville Florida
| |
Collapse
|
6
|
Cauley R, Wu WW, Doval A, Chaikof E, Ho KKL, Iorio ML. Identifying Complications and Optimizing Consultations following Transradial Arterial Access for Cardiac Procedures. Ann Vasc Surg 2018; 56:87-96. [PMID: 30342206 DOI: 10.1016/j.avsg.2018.07.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/15/2018] [Accepted: 07/30/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The radial approach to cardiac procedures has become increasingly common. Although previous studies have suggested a favorable risk profile, serious complications can occur. The purpose of this study is to examine the incidence, subsequent treatment, and outcome of all suspected significant neurovascular complications following transradial cardiac procedures at a large US hospital. METHODS We reviewed all patients who underwent a left heart catheterization, coronary angiogram, or percutaneous coronary intervention via the transradial approach at a single large academic medical center in the United States between 2010 and 2016. Consultations to the vascular and hand surgery services were examined to assess demographic variables, risk factors, presenting symptoms, subsequent treatment, and outcome of all serious complications. RESULTS A total of 9,681 radial access cardiac procedures were performed during the study period. Twenty-four cases (0.25%) were suspected to have major complications and subsequently received consults. A total of 18 complications were diagnosed, including 8 vascular injuries or perforations, 4 hematomas, 4 radial artery occlusions, 1 case of compartment syndrome, and 1 severe radial artery spasm. Of the complications noted, 3 (16.7%) required operative interventions, but all recovered neurovascular function. CONCLUSIONS Radial artery access for cardiac procedures has become increasingly common and has been associated with a low rate of major peripheral neurovascular complications. The majority (83.3%) of complications were successfully treated with a nonoperative management algorithm.
Collapse
Affiliation(s)
- Ryan Cauley
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Winona W Wu
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Andres Doval
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Elliot Chaikof
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Kalon K L Ho
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Matthew L Iorio
- Division of Plastic and Reconstructive Surgery, University of Colorado School of Medicine, Aurora, CO.
| |
Collapse
|
7
|
TATLI ERSAN, BUTURAK ALI, CAKAR AKIF, VATAN BULENTM, DEGIRMENCIOGLU ALEKS, AGAC TARM, KILIC HARUN, GUNDUZ HUSEYIN, AKDEMIR RAMAZAN. Unusual Vascular Complications Associated with Transradial Coronary Procedures Among 10,324 Patients: Case Based Experience and Treatment Options. J Interv Cardiol 2015; 28:305-12. [DOI: 10.1111/joic.12206] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- ERSAN TATLI
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - ALI BUTURAK
- Department of Cardiology; Acibadem University School of Medicine; Istanbul Turkey
| | - AKIF CAKAR
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - BULENT M. VATAN
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - ALEKS DEGIRMENCIOGLU
- Department of Cardiology; Acibadem University School of Medicine; Istanbul Turkey
| | - TARıK M. AGAC
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - HARUN KILIC
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - HUSEYIN GUNDUZ
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - RAMAZAN AKDEMIR
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| |
Collapse
|
8
|
Abstract
The transradial approach for coronary angiography has become an increasingly used alternative to the conventional transfemoral approach. Decreased access site complications and bleeding, reduced hospital stays and health care costs, and increased patient satisfaction contribute to the attractiveness of this approach. However, operators must be familiar with the distinct complications associated with the transradial approach. In this article, we discuss the common and less common complications of transradial catheterization, prevention strategies, and management options.
Collapse
|
9
|
Dutton JW, McClellan WT. Radial arteriovenous fistula following percutaneous coronary intervention: a rare case. Plast Reconstr Surg 2014; 134:495e-497e. [PMID: 25158739 DOI: 10.1097/prs.0000000000000481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J Walter Dutton
- West Virginia University School of Medicine Plastic and Reconstructive Surgery, West Virginia University, Morgantown, W.Va
| | | |
Collapse
|
10
|
Coluccia V, Burzotta F, Trani C, Brancati MF, Niccoli G, Leone AM, Schiavoni G, Crea F. Management of the access site after transradial percutaneous procedures. J Cardiovasc Med (Hagerstown) 2013; 14:705-13. [DOI: 10.2459/jcm.0b013e3283577374] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
11
|
Postcatheterization radial arteriovenous fistula: balloon-assisted direct percutaneous embolization with N-butyl cyanoacrylate and 50 % glucose solution in two sessions. Jpn J Radiol 2013; 31:505-10. [DOI: 10.1007/s11604-013-0206-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
|
12
|
|
13
|
Dehghani P, Culig J, Patel D, Kraushaar G, Schulte P. Arteriovenous fistula as a complication of transradial coronary angiography: a case report. J Med Case Rep 2013; 7:21. [PMID: 23316970 PMCID: PMC3562163 DOI: 10.1186/1752-1947-7-21] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 11/26/2012] [Indexed: 12/20/2022] Open
Abstract
Introduction Iatrogenic arteriovenous fistula is a vascular condition that may result from coronary angiography. Many case reports have described arteriovenous fistula occurrence after coronary angiography using the transfemoral access route, but rarely as a complication of using the transradial approach. We report a rare case of a patient with arteriovenous fistula following transradial artery coronary angiography. Case presentation A 62-year-old Caucasian man underwent emergent coronary angiography using the right radial artery approach. One month after angiography, he discovered a turbulent sound near the access site. A right radial arteriovenous fistula was found upon duplex ultrasound investigation. The patient was treated conservatively. At 1-year follow-up, the arteriovenous fistula was unchanged and the patient remained hemodynamically stable and asymptomatic. Conclusion Iatrogenic arteriovenous fistula is a rare vascular complication of transradial artery coronary angiography. The natural history of arteriovenous fistula is benign and is thought to resolve spontaneously; therefore, a conservative approach, as opposed to surgical ligation, is recommended as the first-line treatment.
Collapse
Affiliation(s)
- Payam Dehghani
- Prairie Vascular Research Network; Department of Cardiology, University of Saskatchewan, 2574 Linner Way, Regina, SK S4V 1K3, Canada.
| | | | | | | | | |
Collapse
|
14
|
Yang JH, Gwon HC, Park JE, Song YB. Arteriovenous fistula of the wrist after transradial coronary intervention. Heart Lung 2012; 41:203-6. [DOI: 10.1016/j.hrtlng.2011.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 06/20/2011] [Accepted: 06/21/2011] [Indexed: 11/29/2022]
|