Procedural decisions in the context of vascular substrate vulnerability: Lessons from vascular Ehlers-Danlos syndrome

The case by Savoie-White et al1 is a sobering reminder that in patients with vascular Ehlers-Danlos syndrome (VEDS), even minor procedural trauma can trigger serious vascular injury. In contrast with the general population, where radial artery cannulation is considered routine, patients with VEDS face a distinct set of risks owing to defective type III collagen. The resulting structural compromise leads to thin adventitia, decreased elasticity, and heightened susceptibility to dissection, rupture, and arteriovenous fistula (AVF).