Jornal Vascular Brasileiro
https://app.periodikos.com.br/journal/jvb/article/doi/10.1590/1677-5449.008618
Jornal Vascular Brasileiro
Case Report

Fístula arteriovenosa pós-cateterismo radial com repercussões cardiopulmonares

Arteriovenous fistula after radial catheterization with cardiopulmonary repercussions

Alexandre Faraco de Oliveira; Alexandre David Ribeiro; Marcio Costa Silveira Ávila

Downloads: 2
Views: 2009

Resumo

Resumo: O presente artigo relata o caso de um paciente coronariopata de 86 anos submetido a cateterismo cardíaco via acesso radial à esquerda. Cerca de 16 meses após o procedimento, manifestou dispneia sem relação com esforço, associada a hipóxia noturna. Apresentava frêmito à palpação do punho esquerdo e foi diagnosticado com fístula arteriovenosa radiocefálica no punho esquerdo. Ao duplex scan apresentava alteração de padrão de onda e aumento da velocidade diastólica compatível com fístula arteriovenosa. Foi submetido a correção cirúrgica da fístula, apresentando melhora clínica e laboratorial após o procedimento. O acesso radial para cateterismo cardíaco tem sido cada vez mais utilizado, principalmente por causar complicações menos frequentes e menos deletérias em comparação ao acesso femoral. Entretanto, complicações como fístula arteriovenosa ocorrem e podem ser especialmente prejudiciais em pacientes octogenários.

Palavras-chave

fístula arteriovenosa, cateterismo cardíaco, intervenção coronária percutânea, dispneia

Abstract

Abstract: This article describes the case of an 86-year-old coronary disease patient who underwent cardiac catheterization via a left radial access. Around 16 months after the procedure, he presented with dyspnea, unrelated to effort, but associated with nocturnal hypoxia. There was a palpable thrill in the left wrist and he was diagnosed with a radiocephalic arteriovenous fistula in the left wrist. A duplex scan revealed an abnormal wave pattern and increased diastolic velocity compatible with arteriovenous fistula. The fistula was repaired surgically and the patient exhibited improvement in clinical and laboratory parameters after the procedure. Radial access is increasingly being used for cardiac catheterization, primarily because it is associated with fewer and less harmful complications than femoral access. However, complications such as arteriovenous fistula occur and can be particularly harmful in octogenarian patients.
 

Keywords

arteriovenous fistula, cardiac catheterization, percutaneous coronary intervention, dyspnea

References

Kolkailah AA, Alreshq RS, Muhammed AM, Zahran ME, Anas El-Wegoud M, Nabhan AF. Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease. Cochrane Database Syst Rev. 2018;4:CD012318. PMid:29665617.

Rigattieri S, Sciahbasi A, Ratib K, et al. Comparison between radial approach and femoral approach with vascular closure devices on the occurrence of access. J Invasive Cardiol. 2016;28(12):473-9. PMid:27630147.

Basu D, Singh PM, Tiwari A, Goudra B. Meta-analysis comparing radial versus femoral approach in patients 75 years and older undergoing percutaneous coronary procedures. Indian Heart J. 2017;69(5):580-8. http://dx.doi.org/10.1016/j.ihj.2017.02.003. PMid:29054180.

Brueck M, Bandorski D, Kramer W, Wieczorek M, Höltgen R, Tillmanns H. A randomized comparison of transradial versus transfemoral approach for coronary angiography and angioplasty. JACC Cardiovasc Interv. 2009;2(11):1047-54. http://dx.doi.org/10.1016/j.jcin.2009.07.016. PMid:19926042.

Carvalho MS, Calé R, Gonçalves PA, et al. Predictors of conversion fron radial into femoral Access in cardiac catheterization. Arq Bras Cardiol. 2015;104(5):401-8. PMid:25789883.

Tatli E, Buturak A, Cakar A, et al. Unusual vascular complications associated with transradial coronary procedures among 10,324 patients: case based experience and treatment options. J Interv Cardiol. 2015;28(3):305-12. http://dx.doi.org/10.1111/joic.12206. PMid:25989895.

Pilan BF, Oliveira AM, Siqueira DED, Guillaumon AT. Tratamento de fístula arteriovenosa adquirida com repercussões hemodinâmicas graves: desafio terapêutico. J Vasc Bras. 2014;13(1):34-. http://dx.doi.org/10.1590/jvb.2014.007.

Alkhouli M, Sandhu P, Boobes K, Hatahet K, Raza F, Boobes Y. Cardiac complications of arteriovenous fistulas in patients with end-stage renal disease. Nefrologia. 2015;35(3):234-45. http://dx.doi.org/10.1016/j.nefro.2015.03.001. PMid:26299166.

Wang EA, Lee MH, Wang MC, Lee HY. Iatrogenic left iliac caval fistula: imaging and endovascular treatment. AJR Am J Roentgenol. 2004;183(4):1032-4. http://dx.doi.org/10.2214/ajr.183.4.1831032. PMid:15385299.

Yared K, Baggish AL, Wood MJ. High-output heart failure resulting from a remote traumatic arteriovenous fistula. Can J Cardiol. 2009;25(4):e143-4. http://dx.doi.org/10.1016/S0828-282X(09)70083-2. PMid:19340363.
 

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5c62b9bb0e88251f1ae1282f jvb Articles

J Vasc Bras

Share this page
Page Sections