Radial Artery Loop Perforation with a Transient Arterio-Venous Fistula during Transradial Catheterization

Transradial access (TRA) is often selected as an alternative route for cardiac catheterization of patients with iliofemoral artery disease or excessive tortuosity. However, anatomical variations of the radial artery are relatively common; radial artery loop is the commonest radial anomaly associated with procedural failure. In this report, we present a case of radial artery loop detected during TRA, following perforation of the loop and creation of an arteriovenous fistula with a hydrophilic guide wire. The success of a conservative management strategy using local compression was demonstrated by repeat angiography at the time of cardiac catheterization from the contralateral brachial artery on the following day. As more operators shift practice toward TRA, the importance of this anatomic variant and its associated risk and management will grow and is highlighted in this report.