Rare Complication of Distal Radial Artery Puncture: Arteriovenous Fistula Formation Following Percutaneous Coronary Intervention

Distal radial artery puncture is increasingly utilized in percutaneous coronary intervention (PCI) due to its reduced complication rates compared to conventional approaches. However, arteriovenous fistula (AVF) formation, though rare, remains a potential complication. A 71-year-old man underwent PCI for effort angina of the left main trunk via a distal radial artery (RA) approach. Three years later, he underwent cardiac catheterization and lower limb arteriography for peripheral arterial disease with intermittent claudication. When palpation of the left RA was confirmed, an enlarged cephalic vein with thrill was observed. Ultrasonography revealed an arteriovenous fistula (AVF) with a diameter of 2.0 mm, and arteriography was performed during catheterization to diagnose AVF. Three years after the PCI, the distended cephalic vein was strongly distended, so vascular ligation was performed at another institution. Although a residual, unidentifiable arteriovenous shunt and a weak thrill persisted, the distended cephalic vein showed improvement, and the patient's condition remained favorable. Early detection of distal radial AVFs, potentially manageable by compression, underscores the importance of post-procedural vigilance in PCI patients.