Sheath Tip Radial Artery Disruption as a Mechanism for Forearm Hematoma: Insights from the Distal Radial Artery Approach

Abstract

Abstract Introduction Radial artery occlusion (RAO), Forearm Hematoma (FH), and compartmental syndrome are three well-recognized complications associated with radial artery (RA) access to percutaneous coronary intervention (PCI). There are disparate ways the RA can be damaged, from multiple needling attempts to adverse interactions between the radial sheath, exchange wire, and diagnostic or guiding catheter with the artery. Case presentation We describe a 49-year-old man who had PCI through his right distal RA (dRA) with a straightforward needle puncture, followed by placement of a Terumo® 10cm 6Fr Glidesheath Slender™. After primary PCI to the right coronary artery, right FH developed, but there was neither swelling at the dRA area nor in the hand. He had staged PCI to the left circumflex artery a few days later, and a radial arteriogram was performed using the same access site. This revealed a “circumferential dissection” in the RA, which was likely to have been caused by the tip of the initial radial sheath. Conclusion Hypothetically, the radial sheath can systematically traumatize the RA. It may be the common denominator for RA disruption, RA thrombosis, RAO, FH, and compartmental syndrome in a continuum. Urgent radial arteriography, whenever post-procedural FH is detected, allows for the source of forearm bleeding to be determined and addressed. Trialing this strategy against current watchful conservative management is warranted.