Discussion:
PTCA via trans-radial route is now more common compared to the
trans-femoral route in view of less complication and more patient
comfort.1 Vascular complication includes radial artery
occlusion, pseudoaneurysm, and AVF. In the RIVAL study, none out of 3507
patients in trans-radial route developed AVF in the trans-radial
route.1,2,3 Burzotta et al reported 9 (0.08%) of the
10676 patients who developed AVF post trans-radial
access.1,4
AVF can develop due to combined unnoticed puncture of the superficial
vein and radial artery during access; however, in most cases the
communication seals spontaneously. The factors responsible for radial
AVF include less operator experience, multiple puncture attempts,
inadequate compression for hemostasis.2 The AVF
usually remain asymptomatic or present with mild pain and swelling in
most of the cases. It can rarely lead to ischemic symptoms due to the
stealing of blood and high output cardiac failure due to increased
venous return.
In our case, possible mechanism is combined puncture of radial artery
and vein along with prolonged compression of radial artery proximal to
puncture site which stopped antegrade flow but allowed retrograde flow
and formation of retrograde AVF.
The techniques that can reduce the vascular complication includes
avoiding multiple attempts to access, use sheath size less than the
arterial diameter, ultrasound-guided needle placement and optimum
compression which stops hemorrhage while allowing normal distal
flow.2