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

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 compli...

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Bibliographic Details
Published in:	BMJ case reports Vol. 12; no. 3; p. e227136
Main Authors:	Ghazala, Christopher George, Marrow, Benjamin Alexander, Kearney, Dermot, Harrison, John William Kenneth
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group LTD 12-03-2019 BMJ Publishing Group
Series:	Case Report
Subjects:	Abscess - diagnostic imaging Abscesses Acute coronary syndromes Angina pectoris Angioplasty Antibiotics Cardiovascular disease Case reports Catheters Family medical history Female Fistula Forearm Foreign Bodies - diagnostic imaging Humans Hydrophilic surfaces Infections Intervention Medical imaging Middle Aged Muscle, Skeletal - diagnostic imaging Patients Percutaneous Coronary Intervention Radial Artery - diagnostic imaging Reminder of Important Clinical Lesson Sinuses Surgical Wound Infection - diagnostic imaging Thrombosis Ultrasonic imaging Ultrasonography Vascular Access Devices Vascular surgery Veins & arteries Belgium Europe orthopaedics interventional radiology orthopaedic and trauma surgery interventional cardiology cardiovascular medicine
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Summary:	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.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	1757-790X 1757-790X
DOI:	10.1136/bcr-2018-227136