Radial Arteriovenous Fistula Developed Late after Coronary Angiography: A Case Report
A 61-year-old woman was referred to department of thoracic and cardiovascular surgery with thrill on the right wrist. Two years earlier, she had visited the emergency department of SMG-SNU Boramae Hospital with a recently aggravated chest pain. She underwent emergency coronary angiography (CAG) via the right femoral artery, and percutaneous coronary intervention for the proximal right coronary artery, which was successfully completed. One year after the intervention, she underwent diagnostic CAG via the right radial artery, and was discharged one day after the procedure. About 11 months after the day of the diagnostic CAG, she complained of palpable thrill on the right wrist at the outpatient clinic. She also presented dilated superficial veins on the right forearm, which was very close to the previous puncture site for the diagnostic coronary angiography (). Suspecting radial arteriovenous fistula (AVF) formation, local compressive dressing and elastic bands were applied on the right wrist, with the expectation of spontaneous closure, but there was no effect. After all of that, we planned surgical ligation of the radial AVF.\nA vascular ultrasound scan revealed a tract between the right radial artery and adjacent subcutaneous vein, which suggested radial arteriovenous fistula (). Computed tomography (CT) angiography of the upper extremity was performed, and it showed early visualization of dilated deep and superficial veins of the right forearm in the arterial phase. In addition, the right cephalic, brachial and axillary veins were visualized by contrast media in the arterial phase (). The patient underwent fistulectomy under local anesthesia. The fistula tract between the radial artery and vein was ligated, and the arterial side fistula opening was closed primarily (). She was discharged on postoperative day one without any complications.