- Email: [email protected]
Arteriovenous Radial Fistula
JACC: CARDIOVASCULAR INTERVENTIONS
VOL.
ª 2017 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
-, NO. -, 2017
ISSN 1936-8798/$36.00
PUBLISHED BY ELSEVIER
http://dx.doi.org/10.1016/j.jcin.2017.04.010
IMAGES IN INTERVENTION
Arteriovenous Radial Fistula A Rare and Delayed Complication of Coronary Angiography Isaac Pascual, MD, PHD,a Rebeca Lorca, MD,a Pablo Avanzas, MD, PHD,a Daniel Hernández-Vaquero, MD, PHD,b César Morís, MD, PHDa
A
76-year-old man had been revascularized
fistula between the radial artery and the ipsilateral
with implantation of 2 drug-eluting stents
ulnar vein (Figure 1B, Online Video 1). The study
in the middle right coronary artery because
was completed with vascular ultrasound, which
of an inferior infarct 11 years previously, through
confirmed the existence of an arteriovenous fistula
right radial access. Posterior clinical evolution was
(Figure 1C, Online Video 2). A hyperflux in the venous
good, with preserved systolic function. He was
system and a large diastolic component in the
referred to our center for coronary angiography for
Doppler wave of the radial artery, typical of arterio-
the development of angina in the preceding 3
venous continuity, that disappeared upon compres-
months. Upon examination of vascular access before
sion of the fistula were found. In the vascular surgery
the procedure, large venous system development
department, a conservative treatment approach was
was detected in the medial region of the right forearm
chosen.
(Figure 1A) and a large radial pulse with a manifest
We illustrate a highly developed arteriovenous fistula, which is a very rare and delayed documented
thrill. Coronary angiography was performed through right femoral access, with good results from the pre-
complication of coronary angiography through radial access.
vious stents and a severe circumflex coronary artery lesion that was treated with implantation of 2 drug-
ADDRESS
eluting stents.
Avanzas, Department of Cardiology, Hospital Uni-
Afterward, selective angiography was performed in the right humeral artery, showing a well-developed
From the
a
FOR
CORRESPONDENCE:
Dr.
Pablo
versitario Central de Asturias, Av. Roma s/n, 33011 Oviedo, Spain. E-mail: [email protected].
Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain and the
b
Department of
Cardiovascular Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Manuscript received March 20, 2017; revised manuscript received April 3, 2017, accepted April 6, 2017.
2
Pascual et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL.
Arteriovenous Radial Fistula After Coronary Angiography
-, NO. -, 2017 - 2017:-–-
F I G U R E 1 Arteriovenous Radial Fistula
(A) Visual venous system development in the right forearm. (B) Angiography showing the fistula between the radial artery (A) and the ipsilateral ulnar vein (V). See Online Video 1. (C) Color Doppler vascular ultrasound of the arteriovenous fistula, showing hyperflux in the venous system. See Online Video 2.
KEY WORDS arteriovenous fistula, catheterization, complication, radial
A PPE NDI X For supplemental videos and their legends, please see the online version of this article.
VOL.
ª 2017 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
-, NO. -, 2017
ISSN 1936-8798/$36.00
PUBLISHED BY ELSEVIER
http://dx.doi.org/10.1016/j.jcin.2017.04.010
IMAGES IN INTERVENTION
Arteriovenous Radial Fistula A Rare and Delayed Complication of Coronary Angiography Isaac Pascual, MD, PHD,a Rebeca Lorca, MD,a Pablo Avanzas, MD, PHD,a Daniel Hernández-Vaquero, MD, PHD,b César Morís, MD, PHDa
A
76-year-old man had been revascularized
fistula between the radial artery and the ipsilateral
with implantation of 2 drug-eluting stents
ulnar vein (Figure 1B, Online Video 1). The study
in the middle right coronary artery because
was completed with vascular ultrasound, which
of an inferior infarct 11 years previously, through
confirmed the existence of an arteriovenous fistula
right radial access. Posterior clinical evolution was
(Figure 1C, Online Video 2). A hyperflux in the venous
good, with preserved systolic function. He was
system and a large diastolic component in the
referred to our center for coronary angiography for
Doppler wave of the radial artery, typical of arterio-
the development of angina in the preceding 3
venous continuity, that disappeared upon compres-
months. Upon examination of vascular access before
sion of the fistula were found. In the vascular surgery
the procedure, large venous system development
department, a conservative treatment approach was
was detected in the medial region of the right forearm
chosen.
(Figure 1A) and a large radial pulse with a manifest
We illustrate a highly developed arteriovenous fistula, which is a very rare and delayed documented
thrill. Coronary angiography was performed through right femoral access, with good results from the pre-
complication of coronary angiography through radial access.
vious stents and a severe circumflex coronary artery lesion that was treated with implantation of 2 drug-
ADDRESS
eluting stents.
Avanzas, Department of Cardiology, Hospital Uni-
Afterward, selective angiography was performed in the right humeral artery, showing a well-developed
From the
a
FOR
CORRESPONDENCE:
Dr.
Pablo
versitario Central de Asturias, Av. Roma s/n, 33011 Oviedo, Spain. E-mail: [email protected].
Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain and the
b
Department of
Cardiovascular Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Manuscript received March 20, 2017; revised manuscript received April 3, 2017, accepted April 6, 2017.
2
Pascual et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL.
Arteriovenous Radial Fistula After Coronary Angiography
-, NO. -, 2017 - 2017:-–-
F I G U R E 1 Arteriovenous Radial Fistula
(A) Visual venous system development in the right forearm. (B) Angiography showing the fistula between the radial artery (A) and the ipsilateral ulnar vein (V). See Online Video 1. (C) Color Doppler vascular ultrasound of the arteriovenous fistula, showing hyperflux in the venous system. See Online Video 2.
KEY WORDS arteriovenous fistula, catheterization, complication, radial
A PPE NDI X For supplemental videos and their legends, please see the online version of this article.