Retention and fracture of a hydrophilic radial artery sheath due to severe spasm

摘要

During withdrawal of the final diagnostic catheter over the J tipped 0.035" wire, some resistance was noted, most likely due to radial artery spasm. On attempting to remove the radial sheath, there was marked resistance, leading to administration of a further intra-arterial GTN 200 ug, intra-arterial verapamil 2.5 mg and intravenous (iv.) midazolam 2 mg. We also performed fluoroscopy with a small volume of contrast through the side port of the sheath, which did not demonstrate any features suggestive of radial artery dissection or perforation, but demonstrated features consistent with diffuse spasm near to the sheath and away from it (fluoroscopy image acquired but unfortunately not archived - we acknowledge the importance of a cine acquisition and storage).