Author + information
- Received December 30, 2013
- Revision received January 20, 2014
- Accepted January 30, 2014
- Published online September 1, 2014.
- Ander Regueiro, MD∗,†,
- Xavier Freixa, MD∗,†∗ (, )
- Yolanda Bartolomé, RN∗,
- Carmen Postigo, RN∗,
- Silvia Sales, RN∗ and
- Joan Falcó, MD‡
- ∗Cardiology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
- †Cardiology Department, Hospital General de Catalunya, Barcelona, Spain
- ‡Interventional Radiology Department, Hospital General Catalunya, Barcelona, Spain
- ↵∗Reprint requests and correspondence:
Dr. Xavier Freixa, Cardiology Department, Hospital General de Catalunya, Josep Trueta, s/n, 08190, Sant Cugat del Vallés, Barcelona, Spain.
Although the incidence of radial arteriovenous fistula after percutaneous coronary intervention is extremely rare (1), its presence might be associated with disabling symptoms requiring invasive treatment (2,3) or surgery (4).
A 56-year-old man with a history of myocardial infarction treated with percutaneous coronary intervention through the right radial artery consulted the outpatient clinic with recurrent pain at the right wrist 1 year after the intervention. Physical exam revealed a pulsatile mass with thrill at the level of the distal right radial artery (Figure 1) that appeared 3 months before consulting. Echo-Doppler showed a clear arteriovenous fistula with a large neck (23 mm) (Figure 2) and severe vein dilation at the level of the mass.
Considering the persistent pain and the failure of conservative measures with external compression, invasive treatment with endovascular sealing was planned.
Anterograde transbrachial access with a 6-F introducer was performed, and a large arteriovenous fistula was confirmed on angiography (Figure 3). A 6-F multipurpose guiding catheter and a Hi-Torque Balance Heavyweight guidewire (Abbott Vascular, Santa Clara, California) were used to implant a 2.8 × 16-mm Graftmaster stent (Abbott Vascular). Control angiography revealed a residual leak at the proximal edge of the first stent, and a larger covered stent (Graftmaster 3.2 × 16 mm) was overlapped proximally. The final angiogram showed complete sealing with normal flow and a patent distal palmar arch (Figure 4). The patient was discharged 1 day after the procedure pain free and with a good radial pulse. Antiplatelet recommendation consisted of aspirin 100 mg/day indefinitely and clopidogrel 75 mg/day for 1 month.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 30, 2013.
- Revision received January 20, 2014.
- Accepted January 30, 2014.
- American College of Cardiology Foundation