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Iatrogenic radial arteriovenous fistula closure via intraluminal compression in a patient with fibromuscular dysplasia
  1. Evan M Luther1,
  2. Eric Huang1,
  3. Hunter King2 and
  4. Eric Peterson1
  1. 1Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
  2. 2Neurological Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Evan M Luther; evan.luther{at}jhsmiami.org

Abstract

Fibromuscular dysplasia (FMD) is an arteriopathy of medium-sized vessels causing pathological arterial wall fragility. However, only minimal data exist on evaluating the risk of transradial access (TRA) in these patients. We describe the case of a woman in her 70s who underwent left middle meningeal artery embolisation for an acute-on-chronic subdural haematoma via right TRA. Radial angiography demonstrated significant FMD throughout the entire right upper extremity. To prevent radial spasm, a 23 cm sheath was placed without difficulty. However, follow-up angiography demonstrated the presence of a new radial arteriovenous fistula (AVF) just distal to the brachial bifurcation. Since no forearm haematoma or limb ischaemia developed, the procedure was continued transradially. After embolisation, the guide catheter was removed and follow-up angiography demonstrated resolution of the fistula. This case illustrates that, in the absence of concerning clinical signs, compression from the guide catheter alone may facilitate thrombosis of an acutely identified iatrogenic radial AVF.

  • radiology (diagnostics)
  • neuroimaging
  • trauma CNS /PNS
  • interventional radiology
  • neurosurgery

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Footnotes

  • Twitter @evanluthermd

  • Contributors EL: Conceptualisation, data curation, writing and editing. EH: Writing and editing. HK: Writing and editing. EP: Writing, editing and supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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