open access

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Case Reports
Published online: 2019-07-01
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Intravascular knot as a complication of tortuosity at innominate-arch junction unravelled by counter-clockwise rotation- simple solution to complex problem

Santosh Kumar Sinha, Kumar Himanshu, Puneet Aggarwal, Mahmodulla Razi
DOI: 10.5603/FC.a2019.0070

open access

Ahead of print
Case Reports
Published online: 2019-07-01

Abstract

Transradial approach scores over transfemoral approach as it is associated with less complications, mortality, and morbidity. Though right sided approach is more convenient for manipulating catheters and devices, aorto-subclavian tortuosity may result into looping, entrapment, kinking, and rarely intravascular knot formation. Here, we describe a case of a 60-year old female which had gone transradial catheterization from right side. Due to aorto-innominate tortuosity, excessive clockwise torque was applied to the catheter to cannulate right coronary artery which resulted into pressure damping, and intravascular knot formation in brachial artery. It was unravelled by counter clockwise rotation of catheter, and thus completing the procedure.

Abstract

Transradial approach scores over transfemoral approach as it is associated with less complications, mortality, and morbidity. Though right sided approach is more convenient for manipulating catheters and devices, aorto-subclavian tortuosity may result into looping, entrapment, kinking, and rarely intravascular knot formation. Here, we describe a case of a 60-year old female which had gone transradial catheterization from right side. Due to aorto-innominate tortuosity, excessive clockwise torque was applied to the catheter to cannulate right coronary artery which resulted into pressure damping, and intravascular knot formation in brachial artery. It was unravelled by counter clockwise rotation of catheter, and thus completing the procedure.

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Keywords

Aorto-innominate tortuosity; Transradial approach; Intravascular knot

About this article
Title

Intravascular knot as a complication of tortuosity at innominate-arch junction unravelled by counter-clockwise rotation- simple solution to complex problem

Journal

Folia Cardiologica

Issue

Ahead of print

Published online

2019-07-01

DOI

10.5603/FC.a2019.0070

Keywords

Aorto-innominate tortuosity
Transradial approach
Intravascular knot

Authors

Santosh Kumar Sinha
Kumar Himanshu
Puneet Aggarwal
Mahmodulla Razi

References (5)
  1. Ratib K, Mamas MA, Routledge H, et al. Access site selection for primary PCI: the evidence for transradial access is strong. Heart. 2012; 98(18): 1392; author reply 1392–3.
  2. Carrillo X, Mauri J, Fernandez-Nofrerias E, et al. Safety and efficacy of transradial access in coronary angiography: 8-year experience. J Invasive Cardiol. 2012; 24(7): 346–351.
  3. Schueler A, Black SR, Shay N. Management of transradial access for coronary angiography. J Cardiovasc Nurs. 2013; 28(5): 468–472.
  4. Gupta PN, Praveen GK, Ahmed SZ, et al. Knots in the cath lab, an embarrassing complication of radial angiography. Heart Asia. 2013; 5(1): 36–38.
  5. Patel T, Shah S, Pancholy S. A simple approach for the reduction of knotted coronary catheter in the radial artery during the transradial approach. J Invasive Cardiol. 2011; 23(5): E126–E127.

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