Infected chronic sinus secondary to a retained fragment of radial artery introducer sheath following percutaneous coronary intervention (PCI)

Abstract

Coronary angiography and percutaneous coronary intervention (PCI) are frequently performed procedures in the UK and the developed world, with the radial artery becoming the preferred route of access. A chronically retained macroscopic fragment of radial artery introducer sheath is a very rare complication that has not, to our knowledge, been reported. We report the case of a 62-year-old woman who underwent PCI and developed a persisting infected sinus and abscess at the cannulation site despite multiple courses of antibiotics. Surgical exploration of the forearm recovered a foreign body that was found in the brachioradialis muscle and resembled a fragment of hydrophilic sheath. In conclusion, this case highlights that it is possible to leave macroscopic fragments of hydrophilic sheaths in situ. This is likely to be encountered during difficult access, especially during arterial spasm, and it is advised that the sheath and any other vascular access device is thoroughly inspected following removal.

Brachial Plexus Block for Removal of Retained Radial Artery Sheath

“…Although retention of a radial sheath is uncommon, it has been described after angiographic procedures [15,16]. Complications from retained RA catheters have been reported to include persistent bleeding, cannulation site infection, and granuloma [17][18][19]. A technique to consider when putting large bore, and/or lengthy catheters into the RA, with the possibility of multiple exchanges or cannulation attempts, is to perform regional anesthesia, either alone, or in combination with GA, in order to ensure continuous vasodilation either during or after the procedure.…”