An arteriovenous fistula is an abnormal connection between an artery and vein resulting in a disrupted blood flow pattern. Arteriovenous fistulas may occur congenitally, be surgically created for hemodialysis, or result from trauma or erosion of an arterial aneurysm. Femoral arteriovenous fistulas are a well-documented complication of cardiac catheterization by a femoral approach, occurring at an incidence of approximately 1 percent in the modern era.1,2,4 (SeeVideo, Supplemental Digital Content 1, which shows pertinent clinical and intraoperative findings demonstrating radial arteriovenous fistula. This video demonstrates duplex asound findings, intraoperative dissection, and gross specimen following resection, http://links.lww.com/PRS/B73.)
In contrast, arteriovenous fistulas of the radial artery following catheterization are exceedingly rare, with only two previous reports published in the English-language medical literature. Only small veins are present in the vicinity of the radial puncture site, making arteriovenous fistulas in this region less likely than other vascular complications such as pseudoaneurysms. Duplex ultrasound is the preferred diagnostic tool for confirmation of arteriovenous fistulas. Although radial artery arteriovenous fistulas are rare, the rapidly growing popularity of percutaneous coronary intervention suggests an increased incidence in the future and stresses the importance of clinical suspicion, proper diagnosis, and early surgical intervention.1–4
The authors have no financial interest to declare in relation to the content of this article.
J. Walter Dutton, M.D.
W. Thomas McClellan, M.D.
1. Kwac MS, Yoon SJ, Oh SJ, Jeon DW, Kim DH, Yang JY. A rare case of radial arteriovenous fistula after coronary angiography. Korean Circ J. 2010;40:677–679
2. Goldberg A, Tsipis A, Rosenfeld I. Arteriovenous fistula after cardiac catheterization from a radial approach. Isr Med Assoc J. 2013;15:381–382
3. Lee MS, Wolfe M, Stone GW. Transradial versus transfemoral percutaneous coronary intervention in acute coronary syndrome: Re-evaluation of the current body of evidence. JACC Cardiovasc Interv. 2013;6:1149–1152
4. Perings SM, Kelm M, Jax T, Strauer BE. A prospective study on incidence and risk factors of arteriovenous fistulae following transfemoral cardiac catheterization. Int J Cardiol. 2003;88:223–228
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