A Case Series of Two Traumatic Iatrogenic Radial Arteriovenous Fistulae as Complication of Transradial Coronary Angioplasty

Abstract

BACKGROUND: Since the introduction of transradial access as a site for coronary angiogram or angioplasty, the rates of vascular complications have significantly improved. Because of this, the procedure has become increasingly preferred due to reduced morbidity rates and lower procedural cost. Complications—specifically, arteriovenous fistulae—have become rarer with the use of the transradial approach. This case series presents two cases of traumatic iatrogenic radial arteriovenous fistula as a complication of transradial coronary angioplasty, as well as their management. Case 1: A 59-year-old male who underwent coronary angioplasty due to left anterior descending coronary artery stenosis was noted to have a tender and pulsating mass proximal to the puncture site that started two weeks after the procedure. Bruit was noted on auscultation. A small fistula formation on the distal radial artery, draining to the connecting vein, was noted on ultrasound. Initial compression of the fistula was done for one week with no observable improvement, so the patient underwent surgical repair. Case 2: A 52-year-old female underwent successful coronary angioplasty. Successful hemostasis by compression of a transradial band (TR) over the access site was achieved post-percutaneous coronary intervention. Two weeks after the procedure, the patient complained of a palpable pulsatile mass on her right wrist. Duplex scan of the right forearm showed a small arteriovenous fistula connecting the radial artery to a deep branch of the radial vein. The fistula and swelling spontaneously resolved after compression with TR band for 48 hours. Conclusion: Traumatic iatrogenic radial arteriovenous fistula is a rare complication of a cardiac catheterization procedure using a transradial access approach. Conservative manual compression may be the initial treatment option, but surgical repair may be considered in the presence of hemorrhage, hemodynamic instability, painful limb ischemia, non-healing ulcers and functional impairment. Keywords: radial arteriovenous fistula, coronary angioplasty, transradial compression, surgical ligation.