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.

Keywords: cardiovascular medicine; interventional cardiology; interventional radiology; orthopaedic and trauma surgery; orthopaedics.

Figure 1

Ultrasound scan of the right forearm, demonstrating two linear luminal abnormalities approximately 15 mm in length, which are reminiscent of foreign bodies.

Figure 2

T1-weighted sagittal MRI with contrast, demonstrating a well-circumscribed linear non-enhancing focus measuring 12 mm in length, localised 15 cm proximal to the wrist joint.

Figure 3

Intraoperative photograph showing the hydrophilic sheath within the right brachioradialis muscle.

Figure 4

Two surgical specimens. On the left is the hydrophilic radial artery sheath, and on the right is the excised tract of chronically inflammed tissue.