Gu Fengming, Yu Jiong, Mi Jingyi
Medical College, Soochow University, Suzhou, Jiangsu, China.
Department of Sports Medicine, Wuxi 9th People's Hospital Affiliated to Soochow University, 999 Liangxi Road, Wuxi, 214062, Jiangsu, China.
BMC Surg. 2022 Mar 21;22(1):106. doi: 10.1186/s12893-022-01562-7.
The radial arteriovenous fistula (AVF) is a rare complication occurring after transradial cardiac catheterization. Patients with AVF typically present with signs of venous dilation, such as swelling or palpable thrills. However, neurological complications secondary to radial AVFs are rare. This paper reported a rare case of ischemic steal syndrome that occurred 11 months after the transradial cardiac catheterization, most likely as a consequence of radial arteriovenous fistula.
This paper described a case of a 73-year-old female, who complained of right forearm swelling and radial 1-3 fingers numbness for several months after the catheterized stent surgery through radial approach. Upon Clinical examination, this patient presented with a slight bump and palpable thrill at the distal third of right forearm, and the sensory of radial 1-3 fingers and pinch force was compromised. The Ultrasonography and computed tomography angiography (CTA) of the upper extremity revealed AVF between the right radial artery and the adjacent vein. Microsurgery was performed successfully to ligate the fistula and reconstruct the radial artery. The numbness has gradually improved about 1 week after the surgery, with no recurred swelling. The two-point pinch force and digital sensitivity recovered at the 20-month follow-up. What's more, due to the scarcity of cases, the optimal therapy for iatrogenic radial AVF is controversial. Accordingly, we provided a literature review of previous reports of catheter-related radial AVFs and proposed an algorithm to manage them.
We believe that once an AVF is diagnosed, early treatment options such as compression or surgery are necessary to relieve symptoms and prevent further complications. Otherwise, serious complications can occur, including the ischemic steal syndrome.
桡动脉动静脉瘘（AVF）是经桡动脉心脏导管插入术后发生的一种罕见并发症。患有AVF的患者通常表现出静脉扩张的体征，如肿胀或可触及的震颤。然而，继发于桡动脉AVF的神经并发症很少见。本文报道了一例经桡动脉心脏导管插入术后11个月发生的缺血性盗血综合征罕见病例，很可能是桡动脉动静脉瘘所致。
本文描述了一例73岁女性患者，她在经桡动脉途径进行导管支架手术后数月，主诉右前臂肿胀和桡侧1-3指麻木。临床检查时，该患者右前臂远端三分之一处有轻微肿块且可触及震颤，桡侧1-3指的感觉和捏力受损。上肢超声和计算机断层血管造影（CTA）显示右桡动脉与相邻静脉之间存在AVF。成功进行了显微手术结扎瘘管并重建桡动脉。术后约1周麻木逐渐改善，无肿胀复发。在20个月的随访中，两点捏力和手指感觉恢复。此外，由于病例稀少，医源性桡动脉AVF的最佳治疗方法存在争议。因此，我们对先前关于导管相关桡动脉AVF的报告进行了文献综述，并提出了一种处理它们的算法。
我们认为，一旦诊断出AVF，早期治疗选择如压迫或手术对于缓解症状和预防进一步并发症是必要的。否则，可能会发生严重并发症，包括缺血性盗血综合征。
