Sinha Santosh Kumar, Jha Mukesh Jitendra, Pandey Umeshwar, Razi Mahmodullah, Sharma Awadesh Kumar
Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India.
ARYA Atheroscler. 2025;21(4):1-5. doi: 10.48305/arya.2025.43276.3011.
Radial arteriovenous fistula (AVF) following radial intervention is exceedingly scarce. Here, we report a case of a 73-year-old man who was admitted with acute myocardial ischaemic syndrome and underwent transradial angioplasty of the proximal left anterior descending and circumflex artery. Fourteen months later, he presented with progressive swelling, dilated superficial veins, a palpable thrill, continuous bruit, and tingling at the local site. Doppler ultrasonography (DUS) diagnosed radial AVF with multiple fistulous communications draining into the cephalic vein, confirmed by contrast-enhanced computed tomography (CECT). Local compression using a prolonged compressive bandage (>12 hours) and a DUS probe was attempted but remained ineffectual. A 2.8 × 26 mm Graftmaster stent graft (Abbott Vascular, USA) was deployed into the radial artery across the fistula neck via a transbrachial approach, slowly expanded over 60 seconds at 12 atm pressure, and post-dilated with a 3 × 15 mm noncompliant balloon at 15 atm pressure. A post-procedure angiogram displayed complete closure of the fistula with restoration of palmar arch perfusion. This is the first reported case of successful exclusion of RAVF through transbrachial approach using a ever covered stent, and only the second case overall of percutaneous exclusion using a stent graft.
桡动脉介入术后发生桡动静脉瘘（AVF）极为罕见。在此，我们报告一例73岁男性患者，因急性心肌缺血综合征入院，接受了左前降支近端和回旋支的经桡动脉血管成形术。14个月后，他出现局部进行性肿胀、浅表静脉扩张、可触及震颤、连续性杂音以及刺痛。多普勒超声检查（DUS）诊断为桡AVF，有多个瘘口与头静脉相通，增强计算机断层扫描（CECT）证实了这一诊断。尝试使用延长压迫绷带（>12小时）和DUS探头进行局部压迫，但未成功。通过经肱动脉途径，将一枚2.8×26mm的Graftmaster覆膜支架（美国雅培血管公司）置入桡动脉跨越瘘口颈部，在12个大气压下60秒内缓慢扩张，然后用一枚3×15mm非顺应性球囊在15个大气压下进行后扩张。术后血管造影显示瘘口完全闭合，掌弓灌注恢复。这是首例报告的通过经肱动脉途径使用覆膜支架成功封堵桡AVF的病例，也是总体上第二例使用覆膜支架进行经皮封堵的病例。
