title: Complete "in situ" avulsion of the radial artery complicating transradial coronary rotational atherectomy.
abstract: BACKGROUND
  Transradial percutaneous access (TR) is promoted because of increased patient comfort and convenience as well as a lower risk of access site and cardiac complications in the literature. Increased use of the TR purports a new set of possible complications for which the vascular surgeon must be capable to recognize and manage.
  
  
  METHODS
  A 48-year-old, devout Jehovah's Witness, woman with a history of coronary artery bypass surgery presented with a non-ST-segment elevation acute myocardial infarction. Pretransfer catheterization demonstrated a heavily calcified, 90% distal left main stenosis with an occluded left internal mammary artery graft to the left anterior descending coronary artery. To minimize the risk of bleeding requiring a blood transfusion, a coronary rotational atherectomy via a TR was performed. A nonhydrophilic, 7F sheath was used to accommodate the larger rotational atherectomy burr sizes. The coronary procedure was successful, but the sheath removal was complicated by significant resistance to pullback while the patient complained of severe pain. Post procedure she developed a hematoma with motor and neurological deficits of her hand.
  
  
  RESULTS
  Emergent surgical exploration with fasciotomy was planned. The radial artery was explored and found to be redundant and pulseless, prompting proximal evaluation and revealing complete avulsion of the radial artery at its origin. An intraoperative arteriogram revealed that the brachial and ulnar arteries and interosseous branches were patent and filled the palmar arch and surgical ligation of the radial artery was conducted.
  
  
  CONCLUSIONS
  Vascular surgeons need to be aware of potential complications related to TR which are likely to increase as this method is more widely disseminated.
authors.affiliation: Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: nicolas.mouawad@osumc.edu.
authors.forename: Nicolas J
authors.initials: NJ
authors.lastname: Mouawad
authors.affiliation: Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Quinn
authors.initials: Q
authors.lastname: Capers
authors.affiliation: Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Christopher
authors.initials: C
authors.lastname: Allen
authors.affiliation: Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Iyore
authors.initials: I
authors.lastname: James
authors.affiliation: Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Mounir J
authors.initials: MJ
authors.lastname: Haurani
mesh_terms: D017225:Atherectomy, Coronary / Q000009:adverse effects* / Q000379:methods; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D033221:Jehovah's Witnesses; D008026:Ligation; D008875:Middle Aged; D017534:Radial Artery / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D012068:Religion and Medicine; D012720:Severity of Illness Index; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000175:diagnosis / Q000628:therapy*; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology*