Traumatic Brachial Arteriovenous Fistula - History Also Matters

Abstract

Transradial intervention usually does not mandate history of arm or forearm injury; we report a case of traumatic AV fistula with focal narrowing of brachial artery for which right transradial angiogram could not be performed and coronary angiogram was accomplished from left transradial access. This rare case teaches us the fact that planning a transradial intervention also requires a history of trauma or surgical intervention to arm or forearm to avoid inadvertent complications during transradial access. Communication between an artery and a vein is known as arteriovenous fistula (AVF) which may be congenital, acquired or surgically created. Acquired arteriovenous fistula is most commonly due to traumatic injury. Following vascular injury, a hematoma develops locally, local healing and fibrosis leads to adhesion between artery and vein creating an arteriovenous fistula.1 Large arteriovenous fistula results in high output cardiac failure and rarely accounts for chronic ischaemia.2 Degree of arteriovenous shunting decides the timeframe of clinical presentation which is often subtle with delay in diagnosis. We report a case of post traumatic brachial AV fistula presenting with feeble pulse, difficult radial puncture and right transradial access failure with switch over to right transfemoral access for accomplishing coronary intervention.