The thrill is vanished: Percutaneous exclusion of post trans radial arteriovenous fistula using stent graft through transbrachial approach.

Radial arteriovenous fistula (AVF) following radial intervention is exceedingly scarce. Here, we report a case of a 73-year-old man who was admitted with acute myocardial ischaemic syndrome and underwent transradial angioplasty of the proximal left anterior descending and circumflex artery. Fourteen months later, he presented with progressive swelling, dilated superficial veins, a palpable thrill, continuous bruit, and tingling at the local site. Doppler ultrasonography (DUS) diagnosed radial AVF with multiple fistulous communications draining into the cephalic vein, confirmed by contrast-enhanced computed tomography (CECT). Local compression using a prolonged compressive bandage (>12 hours) and a DUS probe was attempted but remained ineffectual. A 2.8 × 26 mm Graftmaster stent graft (Abbott Vascular, USA) was deployed into the radial artery across the fistula neck via a transbrachial approach, slowly expanded over 60 seconds at 12 atm pressure, and post-dilated with a 3 × 15 mm noncompliant balloon at 15 atm pressure. A post-procedure angiogram displayed complete closure of the fistula with restoration of palmar arch perfusion. This is the first reported case of successful exclusion of RAVF through transbrachial approach using a ever covered stent, and only the second case overall of percutaneous exclusion using a stent graft.