Author + information
- Received March 20, 2017
- Revision received April 3, 2017
- Accepted April 6, 2017
- Published online July 3, 2017.
- Isaac Pascual, MD, PhDa,
- Rebeca Lorca, MDa,
- Pablo Avanzas, MD, PhDa,∗ (, )
- Daniel Hernández-Vaquero, MD, PhDb and
- César Morís, MD, PhDa
- aDepartment of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
- bDepartment of Cardiovascular Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
- ↵∗Address for correspondence:
Dr. Pablo Avanzas, Department of Cardiology, Hospital Universitario Central de Asturias, Av. Roma s/n, 33011 Oviedo, Spain.
A 76-year-old man had been revascularized with implantation of 2 drug-eluting stents in the middle right coronary artery because of an inferior infarct 11 years previously, through right radial access. Posterior clinical evolution was good, with preserved systolic function. He was referred to our center for coronary angiography for the development of angina in the preceding 3 months. Upon examination of vascular access before the procedure, large venous system development was detected in the medial region of the right forearm (Figure 1A) and a large radial pulse with a manifest thrill.
Coronary angiography was performed through right femoral access, with good results from the previous stents and a severe circumflex coronary artery lesion that was treated with implantation of 2 drug-eluting stents.
Afterward, selective angiography was performed in the right humeral artery, showing a well-developed fistula between the radial artery and the ipsilateral ulnar vein (Figure 1B, Online Video 1). The study was completed with vascular ultrasound, which confirmed the existence of an arteriovenous fistula (Figure 1C, Online Video 2). A hyperflux in the venous system and a large diastolic component in the Doppler wave of the radial artery, typical of arteriovenous continuity, that disappeared upon compression of the fistula were found. In the vascular surgery department, a conservative treatment approach was chosen.
We illustrate a highly developed arteriovenous fistula, which is a very rare and delayed documented complication of coronary angiography through radial access.
For supplemental videos and their legends, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 20, 2017.
- Revision received April 3, 2017.
- Accepted April 6, 2017.
- 2017 American College of Cardiology Foundation