Radial Arteriovenous Fistula After Cardiac Catheterization
A 64-year-old man underwent successful salvage angioplasty on an occluded right coronary artery after a failed thrombolysis for an acute inferior myocardial infarction. A second successful stenting procedure was performed 1 week later with Taxus drug-eluting stents (Boston Scientific) on further significant disease in the left mainstem and proximal left anterior descending artery. Both procedures were performed via the right radial approach with a 6F Cook sheath (William Cook Europe). The patient presented 5 weeks later complaining of dilated superficial veins over the right forearm (Figure 1), with an easily palpable thrill at the right radial puncture site. Subsequent Doppler ultrasound imaging demonstrated a radial arteriovenous fistula (Figure 2). Arteriovenous fistula is a well-recognized complication after cardiac catheterization via the femoral or brachial approach, but it has not been reported in previously published series of radial catheter–based procedures. This patient was referred for surgical ligation of the fistula, which was delayed until he completed a 6-month course of clopidogrel.