Author:
Wang Ke,Wen Li,Xie Li,Zhao Maoyu,Liu Xi,Luo Xiaolin,Jin Jun,Qin Zhexue
Abstract
Abstract
Background
Although there are cardiac interventional procedures, certain transradial access complications might be life-threatening.
Case presentation
A 67-year-old male was admitted for coronary angiography due to chest tightness and shortness of breath on exertion. Hours after the right transradial access angiography, the patients complained the right side of chest pain. Emergent chest X-ray revealed a giant mass in the right chest. The right radial artery was reaccessed and subsequent arteriograms confirmed that the presence of a rupture of the branch of right internal mammary artery. Simultaneously, a microcoil was implanted to seal the perforation. The perforation caused a thoracic hematoma measuring 13.8 cm × 6.7 cm, along with a decrease in hemoglobin concentration from 14.1 g/dL to a minimum of 7.8 g/dL. Additionally, the drainage of the hematoma and red blood cells transfusion were carried out. Further, the patient underwent ascending aortic replacement, aortic valve replacement, mitral valve replacement, and thoracic hematoma removal. Postoperative echocardiography showed that the prosthetic valves were properly positioned and functioning normally. The patient recovered well after the surgery and remained event-free during the latest 14moth follow-up period.
Conclusions
Vascular perforation and subsequent hematoma might occur due to guidewire maneuvering during transradial approach. Awareness of prevention, early recognition and management of access complications may help reduce the occurrence and severity of complications related to the transradial approach.
Funder
Project for Young Talented Doctors of Xinqiao Hospital Affiliated to Army Medical University
National Natural Science Foundation of China
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine
Reference27 articles.
1. Roy S, Kabach M, Patel DB, Guzman LA, Jovin IS. Radial artery access complications: Prevention, diagnosis and management. Cardiovasc Revasc Med; 2021.
2. Sandoval Y, Bell MR, Gulati R. Transradial Artery Access Complications. Circ Cardiovasc Interv. 2019;12(11):e007386.
3. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation Task Force for the management of Acute Coronary Syndromes in patients presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267–.
4. O’Gara PT. 2013 ACCF/AHA Guideline for the management of ST-Elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines (vol 127, pg e362, 2013). Circulation. 2013;128(25):E481–1.
5. Jolly SS, Yusuf S, Cairns J, Niemela K, Xavier D, Widimsky P, Budaj A, Niemela M, Valentin V, Lewis BS, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011;377(9775):1409–20.