Arteriovenous fistula after cardiac catheterization from a radial approach.

A 55 year old woman was admitted with acute anterior ST-elevation myocardial infarction. Treatment with aspirin, clopidogrel, heparin and eptifibatide was initiated and an emergent cardiac catheterization was performed from the right radial approach using a Terumo 6-Fr 10 cm hydrophilic sheath. She had severely reduced left ventricular function and thrombotic occlusion of proximal left anterior descending artery. Primary angioplasty with thrombus aspiration and implantation of a Yukon Choice 3/32 mm (Translumina GmbH, Germany) bare metal stent was successfully performed. The eptifibatide infusion was continued for the next 24 hours. The patient’s further hospital course was uneventful and she was discharged home in stable condition with a treatment regimen of aspirin, clopidogrel, bisoprolol and atorvastatin. Two months later the patient presented with dilated veins of her right wrist and hand [Figure A]. There was a palpable For editorial see page 301