19 Mar 2021
Radial sheath fracture removed surgically after severe radial spasm
Radial artery spasm is inevitable when dealing with small caliber one, especially in calcified radial artery. We describe a case in which radial sheath broke due to severe radial spasm and successfully removed by vascular surgical extraction.
This case was originally published on Twitter by @w_jyg via #CardioTwitterCase (Courtesy of Aly Tohamy)
Clinical presentation
This is the case of a 75-year-old man who presented with crescendo angina in spite of optimal medical treatment. After standard right radial artery access via 6F sheath, we noticed that sheath was introduced both with difficulty and painfully, so we stopped pushing the sheath and gave intraarterial 100 micrograms NTG and 2.5 mg verapamil to treat severe radial spasm.
Case Management
Then, we negotiated J shaped wire successfully but we noticed some calcification and tortuosity in right subclavian artery region.
We performed diagnostic coronary angiography which revealed MVD coronaries as we noticed critical stenosis in RCA as well as LAD CTO.
We decided to stop and take heart team decision. Unfortunately, when trying to pull the radial sheath out, there was arm pain and suddenly a fragment of the sheath came out.
We did multiple trials to remove entrapped part of the sheath in the radial artery but unfortunately failed.
Finally, vascular surgical consultation was done. Surgical removal of the entrapped part of the sheath was done with successful repair and hemostasis of the radial artery.
Patient was discharged safely.
Original tweet and Twitter discussion
A case of post pci radial sheath broken due to severe radial spasm ➡️ surgical extraction & radial artery repair.
— DrPatWJyg (@w_jyg) February 7, 2021
Courtesy from Aly Tohamy. #RadialSpasm#RadialFirst@RadialFirstBot@BotPci@PCRonline@APSIC6pic.twitter.com/0mAA6Li6Ly
Author
