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Hashimoto S, Banshodani M, Marubayashi S, Shintaku S, Moriishi M, Tsuchiya S, Kawanishi H. Iatrogenic arteriovenous fistula in the brachial artery after percutaneous coronary intervention in a patient with end stage kidney disease. J Vasc Access 2024; 25:1011-1014. [PMID: 36856231 PMCID: PMC9982409 DOI: 10.1177/11297298231158427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/02/2023] [Indexed: 03/02/2023] Open
Abstract
Iatrogenic arteriovenous fistula (AVF) is a complication accompanying venous and arterial puncture. Herein we report a case of ligation closure of an iatrogenic AVF in the brachial artery after percutaneous coronary intervention (PCI) for the patient with end-stage kidney disease (ESKD). A 68-year-old woman presented with a history of several coronary angiographies (CAG) and PCI through the right brachial artery. After PCI, the patient experienced a thrill in the right elbow. Two years later, the patient initiated hemodialysis (HD) using a temporary HD catheter for ESKD and congestive cardiac failure. Ultrasonography and computed tomographic angiography revealed an iatrogenic AVF between the right brachial artery and the medial brachial vein. Blood flow in the brachial artery was 760 mL/min. However, the iatrogenic AVF was unusable as vascular access for HD, and prior ligation closure of the iatrogenic AVF was performed, considering the risk of cardiac failure due to double AVFs after the creation of a new AVF for HD. Subsequently, a new radial-cephalic AVF was created in the left forearm. Therefore, clinicians should consider the possibility of iatrogenic AVF in patients with ESKD having a history of CAG or PCI.
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Affiliation(s)
- Shinji Hashimoto
- Department of Kidney Disease and Blood
Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Naka-ku,
Hiroshima, Japan
| | - Masataka Banshodani
- Department of Kidney Disease and Blood
Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Naka-ku,
Hiroshima, Japan
| | - Seiji Marubayashi
- Department of Kidney Disease and
Dialysis Therapy, Akane-Foundation, Ajina Tsuchiya Hospital, Ajina, Hatsukaichi-shi,
Hiroshima, Japan
| | - Sadanori Shintaku
- Department of Kidney Disease and Blood
Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Naka-ku,
Hiroshima, Japan
| | - Misaki Moriishi
- Department of Kidney Disease and Blood
Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Naka-ku,
Hiroshima, Japan
| | - Shinichiro Tsuchiya
- Department of Kidney Disease and Blood
Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Naka-ku,
Hiroshima, Japan
| | - Hideki Kawanishi
- Department of Kidney Disease and Blood
Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Naka-ku,
Hiroshima, Japan
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2
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Scanziani M, Pozzi M, Rovere A, Rezoagli E, Avalli L, Foti G. Arterio-venous fistula causing acute right heart failure: A rare complication of veno-arterial extracorporeal membrane oxygenation. Perfusion 2024; 39:420-422. [PMID: 36378150 DOI: 10.1177/02676591221139683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Vascular complications are a major issue in V-A ECMO and can affect long term outcome. Among these, Artero-Venous (AV) fistulas may lead to right heart failure.Case History: A 73-years patient supported with V-A ECMO for post-cardiotomy biventricular failure developed right heart failure after V-A ECMO decannulation, requiring V-A ECMO recannulation. The presence of an AV femoral fistula was incidentally revealed during femoral vein cannulation, from which oxygenated blood was unexpectedly drawn. The angiographic assessment confirmed the presence of a fistula between superficial femoral artery and vein, at the site of the first venous ECMO cannulation. This was caused by the venous cannula that inadvertently passed across the artery and created an AV fistula that was opened by the venous cannula removal. The exclusion of the endovascular fistula allowed the right heart failure resolution.Conclusions: In the presence of right heart failure after recent vascular manipulation, AV fistula should be ruled out.
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Affiliation(s)
| | - Matteo Pozzi
- Department of Emergency and Intensive Care, ASST Monza, Monza, Italy
| | - Antonio Rovere
- Department of Interventional Radiology, ASST Monza, Monza, Italy
| | - Emanuele Rezoagli
- Department of Emergency and Intensive Care, ASST Monza, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Leonello Avalli
- Department of Emergency and Intensive Care, ASST Monza, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giuseppe Foti
- Department of Emergency and Intensive Care, ASST Monza, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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3
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Brendel JM, Mangold T, Lescan M, Schmehl J, Ghibes P, Grimm A, Greulich S, Krumm P, Artzner C, Grözinger G, Estler A. Viabahn stent graft for arterial injury management: safety, technical success, and long-term outcome. CVIR Endovasc 2024; 7:23. [PMID: 38416319 PMCID: PMC10900043 DOI: 10.1186/s42155-024-00435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/06/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The Viabahn stent graft has emerged as an integral tool for managing vascular diseases, but there is limited long-term data on its performance in emergency endovascular treatment. This study aimed to assess safety, technical success, and long-term efficacy of the Viabahn stent graft in emergency treatment of arterial injury. METHODS We conducted a retrospective single tertiary centre analysis of patients who underwent Viabahn emergency arterial injury treatment between 2015 and 2020. Indication, intraoperative complications, technical and clinical success, and major adverse events at 30 days were evaluated. Secondary efficacy endpoints were the primary and secondary patency rates assessed by Kaplan-Meier analysis. RESULTS Forty patients (71 ± 13 years, 19 women) were analyzed. Indications for Viabahn emergency treatment were extravasation (65.0%), arterio-venous fistula (22.5%), pseudoaneurysm (10.0%), and arterio-ureteral fistula (2.5%). No intraoperative adverse events occurred, technical and clinical success rates were 100%. One acute stent graft occlusion occurred in the popliteal artery on day 9, resulting in a 30-day device-related major-adverse-event rate of 2.5%. Median follow-up was 402 days [IQR, 43-1093]. Primary patency rate was 97% (95% CI: 94-100) in year 1, and 92% (95% CI: 86-98) from years 2 to 6. One stent graft occlusion occurred in the external iliac artery at 18 months; successful revascularization resulted in secondary patency rates of 97% (95% CI: 94-100) from years 1 to 6. CONCLUSION Using Viabahn stent graft in emergency arterial injury treatment had 100% technical and clinical success rates, a low 30-day major-adverse-event rate of 2.5%, and excellent long-term patency rates.
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Affiliation(s)
- Jan M Brendel
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Tobias Mangold
- Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Tübingen, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, Tübingen University Hospital, Tübingen, Germany
| | - Jörg Schmehl
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Patrick Ghibes
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Antonia Grimm
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Simon Greulich
- Department of Cardiology and Angiology, Tübingen University Hospital, Tübingen, Germany
| | - Patrick Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | | | - Gerd Grözinger
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany.
| | - Arne Estler
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
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Chen Z, Huang Y, Ye C, Liu J, Liu Y, Tang Y, Fang Z. Case Report: Transcatheter closure of a giant post-traumatic femoral arteriovenous fistula using ventricular septal occluder. Front Surg 2024; 10:1295595. [PMID: 38249311 PMCID: PMC10797860 DOI: 10.3389/fsurg.2023.1295595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/28/2023] [Indexed: 01/23/2024] Open
Abstract
Giant femoral arteriovenous fistulas are comparatively uncommon, typically treated through covered stents, coil embolization, and open surgical repair. Nevertheless, these options may not be appropriate for all patients. Herein, we describe a case of traumatic femoral arteriovenous fistulas that led to drastic dilatation of the femoral arteriovenous system and considerable heart failure symptoms due to prolonged lack of treatment. Given the intricate anatomical location of the fistula and the patient's severe cardiac dysfunction, surgical repair is often unfeasible. Consequently, we adopted an innovative approach in this case, utilizing a ventricular septal occluder device for fistula closure. This constitutes the first report of an arteriovenous fistula transcatheter closure with a septal occluder.
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Affiliation(s)
- Zewei Chen
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yiyuan Huang
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chenxi Ye
- Xiamen Cardiovascular Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Jiale Liu
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuxin Liu
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yirui Tang
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhenfei Fang
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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5
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Shoji K, Kitamura M, Yoshida S, Ono K, Wada N, Nomura T, Keira N, Tatsumi T. Percutaneous Closure Based on Physiological Assessment of an Arteriovenous Fistula in a Patient With Chronic Limb Threatening Ischaemia. EJVES Vasc Forum 2023; 61:3-7. [PMID: 39026616 PMCID: PMC11255652 DOI: 10.1016/j.ejvsvf.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/20/2023] [Accepted: 11/07/2023] [Indexed: 07/20/2024] Open
Abstract
Introduction An arteriovenous fistula (AVF) is a potential complication of endovascular therapy (EVT). Arteriovenous fistula steal syndrome sometimes leads to severe limb ischaemia; however, assessment of peripheral perfusion in AVF has not yet been established. Report A 90 year old woman diagnosed with chronic limb threatening ischaemia underwent EVT. However, subintimal angioplasty of infrapopliteal lesions resulted in AVF formation in the posterior tibial artery (PTA). Revascularisation of the anterior tibial artery and PTA was performed, but severe AVF steal syndrome persisted and wound healing was delayed. An attempt to physiologically assess the effects of AVF closure and perform an AVF closing manoeuvre, if necessary, was performed. The physiological assessment was performed by laser Doppler flowmetry (LDF) and blood flow was temporarily blocked via the AVF at the distal PTA using a 6 F guiding extension catheter. A significant increase in blood flow was observed in the perfused area of the plantar artery. Coil embolisation and covered stent implantation in the PTA completely closed the AVF. During the procedure, peripheral perfusion with LDF gradually increased in the heel and fifth toe. After AVF closure, the skin perfusion pressure values increased significantly, wound healing was accelerated, and complete healing was achieved. Discussion Laser Doppler flowmetry measurements under simulated AVF closure using a guiding extension catheter may be useful for the physiological assessment of peripheral perfusion before percutaneous AVF closure.
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Affiliation(s)
- Keisuke Shoji
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Kyoto, Japan
| | - Michitaka Kitamura
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Kyoto, Japan
| | - Shiori Yoshida
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Kyoto, Japan
| | - Kenshi Ono
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Kyoto, Japan
| | - Naotoshi Wada
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Kyoto, Japan
| | - Tetsuya Nomura
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Kyoto, Japan
| | - Natsuya Keira
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Kyoto, Japan
| | - Tetsuya Tatsumi
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Kyoto, Japan
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6
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Kisling AJ, Symons JG, Daubert JP. Catheter ablation of atrial fibrillation: anticipating and avoiding complications. Expert Rev Med Devices 2023; 20:929-941. [PMID: 37691572 DOI: 10.1080/17434440.2023.2257131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Atrial fibrillation (AF) ablation is being performed more frequently and more widely at more centers. This stems from several factors including 1) demographic forces leading to an increased prevalence of the arrhythmia; 2) greater availability of ambulatory monitoring making diagnosis more frequent; 3) relative inefficacy of medications; and 4) improved safety and efficacy of the procedure. Ablation has become much more streamlined and reproducible than a decade ago, but life-threatening complications may still arise. AREAS COVERED This review will focus on awareness, avoidance, and early recognition and management of complications of AF ablation. This literature review is challenged by differing approaches to ablation of AF both within a center and between centers, the rapid improvement of technology making the outcomes associated with a therapeutic strategy begun a few years prior relatively obsolete, as well as the heterogeneity of the population being studied. EXPERT OPINION Newer technologies are on the horizon which will allow us to ablate AF with increasing efficacy, efficiency, and hopefully safety. Such new technology and changing usage mandate vigilance to avoid complications.
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Affiliation(s)
- Adam J Kisling
- Walter Reed National Military Medical Center, Department of Cardiology, Bethesda, MD, United States of America
| | - John G Symons
- Walter Reed National Military Medical Center, Department of Electrophysiology, Bethesda, MD, United States of America
| | - James P Daubert
- Electrophysiology Section/Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Department of Medicine, Duke University, Durham, NC, United States of America
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7
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Okam NA, Ibe U, Stein R, Galin I. Radial Arteriovenous Fistula After a Left Heart Catheterization: Two Case Reports. Cureus 2023; 15:e38799. [PMID: 37303335 PMCID: PMC10250133 DOI: 10.7759/cureus.38799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
The distal transradial artery (TRA) approach has been increasing in popularity over recent years due to its favorable ergonomics and potential for fewer vascular complications. Other advantages include lower bleeding risk, early ambulation, lower procedural costs, and same-day discharge, resulting in additional cost savings. We discuss two cases of patients who underwent left heart catheterizations through the radial artery access site and afterwards experienced fistula formation. Our case series brings to light a rare occurrence of arteriovenous fistulas (AVFs) following cardiac catheterization via the transradial artery site, thus enhancing our knowledge of the risk associated with this access site. The pathophysiology of AV fistula remains the same regardless of transfemoral or transradial artery use. During the procedure, needle diversion into the venous tributary results in an unrecognized combined artery and vein puncture, which usually seals spontaneously. However, if the communication persists, an AV fistula may occur. The majority of patients who suffer from an iatrogenic AVF as a result of TRA do not develop clinical signs of hemodynamic significance. There are various therapeutic strategies, which include surgical repair, placement of a covered stent, ultrasound-guided compression of the AV fistula, and conservative management. Both of our patients were evaluated by vascular surgery; one of the patients found the constant pulsation and bruit burdensome and underwent surgical repair.
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Affiliation(s)
| | | | | | - Ira Galin
- Cardiology, Danbury Hospital, Danbury , USA
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8
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Tong F, Sun Z. Strategies for Safe Implantation and Effective Performance of Single-Chamber and Dual-Chamber Leadless Pacemakers. J Clin Med 2023; 12:2454. [PMID: 37048538 PMCID: PMC10094832 DOI: 10.3390/jcm12072454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/02/2023] [Accepted: 03/14/2023] [Indexed: 04/14/2023] Open
Abstract
Leadless pacemakers (LPMs) have emerged as an alternative to conventional transvenous pacemakers to eliminate the complications associated with leads and subcutaneous pockets. However, LPMs still present with complications, such as cardiac perforation, dislodgment, vascular complications, infection, and tricuspid valve regurgitation. Furthermore, the efficacy of the leadless VDD LPMs is influenced by the unachievable 100% atrioventricular synchrony. In this article, we review the available data on the strategy selection, including appropriate patient selection, procedure techniques, device design, and post-implant programming, to minimize the complication rate and maximize the efficacy, and we summarize the clinical settings in which a choice must be made between VVI LPMs, VDD LPMs, or conventional transvenous pacemakers. In addition, we provide an outlook for the technology for the realization of true dual-chamber leadless and battery-less pacemakers.
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Affiliation(s)
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, China;
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9
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Kumar AP, Valakkada J, Ayappan A, Kannath S. Management of Acute Complications during Endovascular Procedures in Peripheral Arterial Disease: A Review. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0042-1760246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AbstractEndovascular therapy, as opposed to surgical bypass, has become the mainstay for peripheral arterial disease even in long segment occlusions. Complications can occur during the arterial access, catheter manipulation, balloon dilation, and/or stent placement. Given the high prevalence of comorbidities such as diabetes, hypertension, renal dysfunction, and coronary artery disease in these patients, early identification of procedural complications and initiation of treatment are of paramount importance. This review aims to provide comprehensive data on the identification and management of commonly encountered endovascular complications during endovascular interventions in peripheral arterial disease.
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Affiliation(s)
- Ajay Pawan Kumar
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jineesh Valakkada
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Anoop Ayappan
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Santhosh Kannath
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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10
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Ninama AC, Bellur S, Balasundaram S. Idiopathic Extremity Arteriovenous Fistula: A Rare Etiology of Cardiac Failure. Cureus 2022; 14:e28459. [PMID: 36176886 PMCID: PMC9511214 DOI: 10.7759/cureus.28459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 11/17/2022] Open
Abstract
Idiopathic extremity arteriovenous fistulas are rare, abnormal connections between arteries and veins commonly occurring between iliac vessels. We present the case of a 42-year-old female who was referred to our center for a mitral valve replacement with a one-year history of breathlessness and a six-month history of progressive abdominal distension. Physical examination revealed a pansystolic murmur in the mitral area, basal crepitations, and a non-tender pulsatile swelling in the right iliac fossa. Imaging showed severe mitral regurgitation in heart failure along with a large arteriovenous fistula between the common femoral vessels which suggested that the arteriovenous fistula was the etiology of heart failure. Postoperatively, the patient showed significant improvement in symptoms with imaging. On follow-up, the patient reported no progression of symptoms. Our case demonstrated an idiopathic extremity arteriovenous fistula in an unusual location, unexpectedly causing heart failure despite a significant valvular disease. Therefore, arteriovenous fistulas warrant inclusion in the differential of heart failure despite a valvular lesion and absence of classical signs of high output heart failure, as in our case.
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11
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Kasliwal N, Pfeiffer WB, Eidt JF, Gunn DC, Ramamoorthy S. Iatrogenic Arteriovenous Fistula Secondary to Percutaneous Coronary Intervention Causing Severe Decompensated Heart Failure. Cureus 2022; 14:e27934. [PMID: 36134099 PMCID: PMC9481213 DOI: 10.7759/cureus.27934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 11/05/2022] Open
Abstract
Congestive heart failure has long been a well-known cause of both morbidity and mortality for thousands of people worldwide. Consequences of decompensated heart failure are systemic and widespread, including but not limited to pulmonary edema, dyspnea, hypoxia, peripheral edema, and end-organ hypoperfusion. Common etiologies of congestive heart failure include systemic hypertension, coronary artery disease, longstanding alcohol abuse, valvular dysfunctions, and myocarditis. While the vast majority of congestive heart failure cases are secondary to one of these common etiologies, there is a subset of cases that cannot be traced to any of these causes and are most often grouped under the category of idiopathic. One rarely seen etiology of decompensated heart failure is an arteriovenous fistula, whether naturally occurring or iatrogenic. We report a case of an iatrogenic AV fistula secondary to percutaneous coronary intervention causing severe decompensated heart failure that was successfully treated with surgical ligation.
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12
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Iatrogenic Left Common Carotid Artery to Right Internal Jugular Vein Arteriovenous Fistula Closure. J Vasc Surg Cases Innov Tech 2022; 8:634-637. [PMID: 36248379 PMCID: PMC9556562 DOI: 10.1016/j.jvscit.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/17/2022] [Indexed: 11/21/2022] Open
Abstract
We report a minimally invasive approach to the repair of a 2.8-cm × 6.0-cm left proximal common carotid to right internal jugular vein arteriovenous fistula. A 47-year-old woman with coronavirus disease 2019 pneumonia had received extracorporeal membranous oxygenation and developed a rare, presumably cannulation-related, vascular injury. We used a plug designed and typically used for the endovascular management of a patent ductus arteriosus.
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13
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Villela MA, Sanina C, Pyo R. Vascular Access Site Complications. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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14
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Heiss C, Olinic DM, Belch JJF, Brodmann M, Mazzolai L, Stanek A, Madaric J, Krentz A, Schlager O, Lichtenberg M, Frank U. Management of chronic peripheral artery disease patients with indication for endovascular revascularization. VASA 2022; 51:121-137. [PMID: 35418243 DOI: 10.1024/0301-1526/a000998] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
With an increasing global burden of patients with chronic peripheral artery disease (PAD) the safe and effective provision of lower limb revascularisation is a growing medical need. Endovascular procedures for the treatment of PAD have become a crucial cornerstone of modern vascular medicine, and the first line revascularisation approach if technically feasible and taking patient choice into consideration. With the increasing age of patients with PAD and the increasing number of comorbidities open vascular surgery is also often not feasible. We outline a framework of key messages, endorsed by the board of the European Society of Vascular Medicine for pre-, peri- and post procedural management of patients requiring endovascular arterial procedures of the lower limbs. These key messages emphasize the important and increasing role of interventional vascular physicians.
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Affiliation(s)
- Christian Heiss
- Department of Clinical and Experimental Medicine, University of Surrey, Faculty of Health and Medical Sciences, Guildford, United Kingdom.,Department of Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill, United Kingdom.,The authors contributed equally
| | - Dan-Mircea Olinic
- Iuliu Hatieganu University of Medicine and Pharmacy, Emergency Hospital, Medical Clinic no. 1, Cluj-Napoca, Romania.,The authors contributed equally
| | - Jill J F Belch
- Institute of Cardiovascular Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University, Graz, Austria
| | - Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Agata Stanek
- Department of Internal Diseases, Angiology and Physical Medicine, Medical University of Silesia, Bytom, Poland
| | - Juraj Madaric
- Clinic of Angiology, National Cardiovascular Institute, Bratislava, Slovakia
| | - Andrew Krentz
- Institute for Cardiovascular & Metabolic Research, University of Reading, UK
| | - Oliver Schlager
- Division of Angiology. Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Ulrich Frank
- Department of Angiology, Cantonal Hospital of Grisons, Chur, Switzerland.,The authors contributed equally
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15
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Asemota D, Kassam Z, Voto C, Mangla A, Coven D, Lasic Z. Pseudoaneurysm Formation After "Preclose"-Assisted Impella Insertion in a Patient With Cardiogenic Shock. J Med Cases 2022; 13:202-206. [PMID: 35655626 PMCID: PMC9119370 DOI: 10.14740/jmc3841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/08/2021] [Indexed: 11/11/2022] Open
Abstract
The use of mechanical support devices such as the Impella CP (Abiomed, Danvers, MA) is a growing form of treatment for patients with cardiogenic shock (CS). Despite the increase in usage, there remains a dearth in literature regarding potential complications. Vascular complications such as pseudoaneurysms (PAs) are rare but important potential complications that can occur with use of the Impella. We present Impella-assisted percutaneous coronary intervention (PCI) in a patient with CS, "Preclosed" with the Perclose ProGlide (Abbott, Plymouth, MN) device complicated by development of a PA. A 62-year-old male patient with a history of diabetes and hypertension presented to our emergency room (ER) with chest pain and electrocardiogram (ECG) findings consistent with an acute anterior wall ST-elevation myocardial infarction (STEMI). This was further complicated by refractory CS. The patient was urgently taken to the cardiac catherization laboratory. After exchange of sequential dilators, a single Perclose device was used prior to the insertion of the Impella sheath. The patient then underwent a successful Impella-assisted PCI of his left anterior descending artery. Upon stabilization of hemodynamics, the patient was taken to the catheterization laboratory for Impella removal. After removal of Impella, imaging detected extravasation of contrast, without development of hematoma, later confirmed to be a PA via computed tomography (CT) scans and ultrasound Doppler imaging. The PA was successfully managed with injection of thrombin. The PA was likely caused by shearing forces of the dilators, the 14-F Impella sheath and foot of the device. We propose deploying the Perclose device earlier in the process of dilating the access site to avoid such complication. This is one of the first case reports that detail the occurrence and management of a PA with Impella insertion.
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Affiliation(s)
- Daniel Asemota
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Zain Kassam
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Christian Voto
- Department of Medicine, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Aditya Mangla
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - David Coven
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Zoran Lasic
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
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Abstract
PURPOSE OF REVIEW Vascular access and closure is a key part of endovascular procedures, and access site-related complications are an independent predictor of adverse procedural outcomes. The purpose of this review is to discuss the methods of vascular closure including manual compression, vascular closure devices (VCDs) for both arterial and venous arteriotomies, their mechanisms, and access site-related complications. RECENT FINDINGS Various VCDs have been approved over the last three decades. These devices have different mechanisms to achieve hemostasis and are generally categorized into active and passive approximators. Studies have largely found that they are non-inferior to manual compression. Uncomplicated vascular closure is pertinent to avoid adverse procedure-related outcomes. The emergence of VCDs has reduced time to hemostasis, facilitating early ambulation and discharge and reducing hospitalization cost with comparable complication rate to manual compression. Nonetheless, they should be used in favorable vascular anatomy and are not intended to reduce complications.
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Affiliation(s)
- Sukhdeep Bhogal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving St.Suite 4B-1, Washington, NWDC, 20010, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving St.Suite 4B-1, Washington, NWDC, 20010, USA.
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17
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Russu E, Mureşan AV, Kaller R, Coşarcă CM, Arbănaşi EM, Arbănaşi EM. Case Report: Gigantic Arteriovenous Femoral Fistula Following Cardiac Artery Catheterization. Front Surg 2022; 9:769302. [PMID: 35198595 PMCID: PMC8858822 DOI: 10.3389/fsurg.2022.769302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To present the case of a patient with a 9-mm iatrogenic fistula between a branch of the right profunda femoris artery, aneurysmally dilated at ~1.851cm, and the right femoral vein, successfully treated with open surgical ligation. Case Report A 70-years-old female was referred to the Vascular Surgery Clinic due to worsening cardiac failure symptoms during the previous year. The medical history included a diagnostic cardiac artery catheterism through a Seldinger technique one year and a half ago. A recent ultrasound described velocities characteristic for a high flow arteriovenous communication in the right groin. Two consecutive cardiology exams, performed at nine months from one another, showed a decrease of almost 21% in the ejection fraction of the left ventricle. An angiography was conducted with the hope of achieving effective percutaneous embolization. Unfortunately, that was not the case. An open repair was scheduled, as the option for a stent-graft deployment was overruled as being too risky, potentially closing several branches of the profunda femoris artery and not fully completing the orifice due to a complicated anatomical positioning. Under local anesthesia, an open ligation was performed in very hostile anatomical conditions. The patient had an uncomplicated evolution and was discharged on the third day, symptom-free. Conclusions Iatrogenic arteriovenous fistulas are rare. Clinical presentation diagnoses the case efficiently, vascular imaging being essential for surgical preparation. Though open repair is not the gold standard, there are cases not suitable for the endovascular approach. These patients are eligible for a surgical solution, not without technical challenges.
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Affiliation(s)
- Eliza Russu
- Clinic of Vascular Surgery, Emergency County Hospital, Târgu-Mureş, Romania
- First Department of Surgery, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu-Mureş, Romania
| | - Adrian Vasile Mureşan
- Clinic of Vascular Surgery, Emergency County Hospital, Târgu-Mureş, Romania
- First Department of Surgery, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu-Mureş, Romania
| | - Reka Kaller
- Clinic of Vascular Surgery, Emergency County Hospital, Târgu-Mureş, Romania
| | - Cătălin Mircea Coşarcă
- Clinic of Vascular Surgery, Emergency County Hospital, Târgu-Mureş, Romania
- Department of Anatomy, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu-Mureş, Romania
| | - Eliza-Mihaela Arbănaşi
- Department F2, Discipline of Pharmaceutical and Therapeutical Chemistry, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu-Mureş, Romania
| | - Emil-Marian Arbănaşi
- Clinic of Vascular Surgery, Emergency County Hospital, Târgu-Mureş, Romania
- *Correspondence: Emil-Marian Arbănaşi
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18
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Gooneratne T, Chanaka KAN, Wijeyaratne SM. An unusual case of femoral arteriovenous fistula associated with acute limb ischemia following femoral vein catheterization for hemodialysis. J Vasc Bras 2022; 21:e20210199. [PMID: 35571523 PMCID: PMC9083547 DOI: 10.1590/1677-5449.202101992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
Abstract
Co-occurrence of acute limb ischemia (ALI) and arteriovenous fistula (AVF) as a manifestation of inadvertent arterial injury during percutaneous femoral vein dialysis catheter insertion is a rare and dangerous, but preventable complication. Iatrogenic femoral AVF commonly presents late, with leg swelling or high output cardiac failure. However, the co-occurrence of a femoral AVF with both progressive leg swelling, and acute thromboembolism has not been previously reported. We report the case of an iatrogenic femoral AVF with superficial femoral artery (SFA) thrombosis and distal embolism in a 53-year-old female who underwent percutaneous femoral access for temporary hemodialysis. Both the SFA and AVF were managed with open surgical repair.
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19
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Middleton WD, Robinson KA. Analysis and Classification of Postcatheterization Femoral Arteriovenous Fistulas Based on Color Doppler Examinations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:207-216. [PMID: 33720458 DOI: 10.1002/jum.15696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/08/2021] [Accepted: 02/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To analyze and classify arterial supply and venous drainage of postcatheterization femoral arteriovenous fistulas (AVFs). METHODS A review of extremity Doppler reports identified 77 femoral AVFs in 75 patients. Doppler exams were reviewed retrospectively. Fistulas were classified as above or below the common femoral artery bifurcation and subclassified based on the location of arterial inflow and venous outflow. RESULTS Arterial inflow originated above the femoral bifurcation in 32 cases. The communication was between the common femoral artery and the superficial circumflex iliac vein in 25 of 32 cases and between a branch of the common femoral or external iliac artery and the common femoral or external iliac vein in 4 of 32 cases. In 3 of 32 cases, AVFs arose from the common femoral artery, but the venous outflow was not determined. Arterial inflow originated from the superficial femoral artery in 23 cases. Venous outflow originated from the common femoral vein in 10 of 23 cases, the femoral vein in 7 of 23 cases, and the lateral circumflex femoral vein in 6 of 23 cases. Arterial inflow originated from the deep femoral artery in 12 cases. Venous outflow originated from the common femoral vein in 6 of 12 cases and from the lateral circumflex femoral vein 6 of 12 cases. In 8 cases, the AVF originated below the bifurcation, but the arterial inflow was not classified. In 2 cases, it was impossible to determine if the AVF originated above or below the bifurcation. CONCLUSIONS Iatrogenic femoral AVFs arise above the femoral bifurcation more often than previously recognized. Classification based on the arterial inflow and venous outflow provides a straightforward means of describing these fistulas.
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Affiliation(s)
- William D Middleton
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
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20
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Georgeades C, Rothstein AE, Plunk MR, Arendonk KV. Iatrogenic vascular trauma and complications of vascular access in children. Semin Pediatr Surg 2021; 30:151122. [PMID: 34930587 DOI: 10.1016/j.sempedsurg.2021.151122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Vascular access is frequently a critical component of the diagnostic and therapeutic procedures required to manage childhood illnesses, including many emergent conditions and critical illnesses. Vascular access in the pediatric population presents unique challenges, and many clinical and technical factors must be considered to avoid complications that can occur with vascular access procedures. This article reviews various aspects of vascular access and associated iatrogenic trauma in children, including risk factors, management of complications, and preventive measures to avoid complications. It is only with a comprehensive understanding of the topic that vascular access in children can be performed safely, effectively, and efficiently.
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Affiliation(s)
- Christina Georgeades
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 999N 92nd Street, Suite 320, Milwaukee, WI 53226, United States.
| | - Abby E Rothstein
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, 8701W. Watertown Plank Road, Milwaukee, WI 53226, United States
| | - Matthew R Plunk
- Department of Radiology, Children's Wisconsin and Medical College of Wisconsin, 9000W. Wisconsin Avenue, MS-721, Milwaukee, WI 53226, United States
| | - Kyle Van Arendonk
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 999N 92nd Street, Suite 320, Milwaukee, WI 53226, United States
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21
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Detachable coil embolisation for iatrogenic femoral arteriovenous fistula in patients with CHDs. Cardiol Young 2021; 31:1698-1700. [PMID: 33827747 DOI: 10.1017/s1047951121001347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present two cases of patients with iatrogenic femoral arteriovenous fistula who underwent successful embolisation using three-dimensional shape detachable coils. A 49-year-old male with Tetralogy of Fallot had arteriovenous fistula which developed from the common femoral artery to the femoral vein with an aneurysm and a 17-year-old female with single ventricle after total-cavo-pulmonary-connection had two arteriovenous fistulas which developed from the internal iliac artery to the femoral vein. A total of six and seven pieces of detachable coils were necessary for complete occlusion, respectively. No complications were recorded. The advantage of the detachable coil is a wide variation and repositioning until the coil achieves good stabilisation and an ideal configuration.
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22
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Gunawardena T, Subramaniyam P, Cassim R, Wijeyaratne M. Severe leg swelling following removal of a temporary femoral venous hemodialysis catheter. Semin Dial 2021; 34:263-265. [PMID: 33896031 DOI: 10.1111/sdi.12976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/22/2021] [Accepted: 04/03/2021] [Indexed: 11/28/2022]
Abstract
Temporary central venous catheters are commonly used for patients who require emergency hemodialysis (HD). An arteriovenous fistula (AVF) is a rare complication of this procedure. In this case report, we present a patient who was diagnosed with an iatrogenic femoral AVF after cannulation of the right femoral vein with a temporary HD catheter.
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Affiliation(s)
- Thilina Gunawardena
- University Vascular Surgical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Prasath Subramaniyam
- Department of Vascular Surgery, Teaching Hospital Kurunegala, Kurunegala, Sri Lanka
| | - Rezni Cassim
- University Vascular Surgical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Mandika Wijeyaratne
- University Vascular Surgical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
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23
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Lin JX, Hill A. Delayed presentation of an iatrogenic, traumatic brachio-brachial fistula. Trauma Case Rep 2021; 32:100438. [PMID: 33665327 PMCID: PMC7907532 DOI: 10.1016/j.tcr.2021.100438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2021] [Indexed: 11/24/2022] Open
Abstract
Iatrogenic arteriovenous fistulae are rare occurrences after venepuncture, line placement or trauma. Presentations and symptoms can vary but they are usually identified soon after the causative injury due to the development of a visible, palpable, and pulsatile lump that can be concerning for patients. We describe the presentation and management of an unusual case of delayed presentation of an iatrogenic, traumatic brachio-brachial fistula.
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Affiliation(s)
- Jin Xin Lin
- Vascular Department, Auckland City Hospital, ADHB, New Zealand
| | - Andrew Hill
- Vascular Department, Auckland City Hospital, ADHB, New Zealand
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24
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Yoshikawa T, Katsumori T, Hisano M, Yasumura T, Sasakura Y. Transcatheter arterial embolization for a symptomatic Tarlov cyst with hemorrhage due to an underlying arteriovenous fistula. Radiol Case Rep 2021; 16:1284-1287. [PMID: 33854665 PMCID: PMC8027132 DOI: 10.1016/j.radcr.2021.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/25/2022] Open
Abstract
Symptomatic sacral perineural cysts (Tarlov cysts) accompanied by intra-cyst hemorrhage are rare. The treatment strategies have not been established. We report a 57-year-old woman with severe back pain due to a Tarlov cyst accompanying intracyst hemorrhage. Computed tomography angiography revealed an arteriovenous fistula (AVF) at the area surrounding the cyst. The patient underwent transcatheter arterial embolization for the AVF. Thereafter, the hematoma and cyst decreased in size, and clinical symptoms markedly improved with no additional surgery. Transcatheter arterial embolization may be an effective alternative to surgery for Tarlov cysts with vascular disease, including AVF.
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25
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McHugh S, Noory A, Mishra S, Vanchiere C, Lakhter V. Vascular Access for Large Bore Access. Interv Cardiol Clin 2021; 10:157-167. [PMID: 33745666 DOI: 10.1016/j.iccl.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Recent advances in the field of interventional cardiology have allowed for more complex procedures to be performed percutaneously. Ability to obtain safe large bore vascular access is frequently the key factor to procedural success. Meticulous technique for successful vascular access incorporates the understanding of anatomic landmarks, ultrasound, fluoroscopy, and micropuncture. Adequate hemostasis at the end of the case can be achieved through careful use of commercially available vascular closure devices. Although access-related vascular complications are uncommon, early recognition is key to successful management. Arterial tortuosity and calcification can present a significant challenge to successful common femoral artery access.
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Affiliation(s)
- Stephen McHugh
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Ali Noory
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Suraj Mishra
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Catherine Vanchiere
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Vladimir Lakhter
- Division of Cardiovascular Diseases, Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street (9PP), Philadelphia, PA 19140, USA.
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26
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Zilinyi RS, Sethi SS, Parikh MA, Parikh SA. Iatrogenic Arteriovenous Fistula Following Femoral Access Precipitating High-Output Heart Failure. JACC Case Rep 2021; 3:421-424. [PMID: 34317549 PMCID: PMC8311044 DOI: 10.1016/j.jaccas.2020.12.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/13/2020] [Accepted: 12/22/2020] [Indexed: 11/27/2022]
Abstract
Iatrogenic complications may manifest in a variety of ways. We present the case of an 86-year-old woman who underwent a percutaneous coronary intervention with a drug-eluting stent for non-ST-segment elevation myocardial infarction followed by leadless pacemaker placement through a femoral approach. Her post-procedure course was complicated by new onset high-output heart failure secondary to iatrogenic arteriovenous fistula formation, requiring covered stent placement. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Robert S Zilinyi
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Sanjum S Sethi
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Manish A Parikh
- Division of Cardiology, Department of Medicine, Brooklyn Methodist Hospital/ Weill Cornell Medical, New York, New York, USA
| | - Sahil A Parikh
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
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27
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Youn YJ, Kim CW, Park IH, Byun CS. Delayed Treatment of Iatrogenic Brachial Arteriovenous Fistula. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:408-410. [PMID: 32919442 PMCID: PMC7721528 DOI: 10.5090/kjtcs.20.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/17/2020] [Accepted: 05/28/2020] [Indexed: 11/30/2022]
Abstract
Iatrogenic vascular injuries may occur during venipuncture, arterial cannulation, or catheterization procedures. Brachial arteriovenous fistula (AVF) resulting from antecubital vascular access is rare and develops slowly. We report the case of an 18-year-old man who had developed iatrogenic brachial AVF. He had a history of several venipunctures in the left arm at the age of 10 months. Doppler ultrasonography and computed tomographic angiography were used to establish a diagnosis of brachial AVF, and surgical correction of the AVF was performed. As our case indicates, delayed surgery can be considered as a treatment option and may be associated with a decreased risk of vascular complications in the management of iatrogenic brachial AVF in infants.
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Affiliation(s)
- Young-Jin Youn
- Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Chang Wan Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Il Hwan Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Chun Sung Byun
- Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
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28
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Bounssir A, Taghi H, Sedki N, Bakkali T, Lekehal B. Technical management of traumatic arteriovenous fistula: Tips and tricks. Int J Surg Case Rep 2020; 76:468-473. [PMID: 33207412 PMCID: PMC7586047 DOI: 10.1016/j.ijscr.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Traumatic Arteriovenous Fistulas (AVFs) are a rare complication of vascular injuries and pose a problem of topographic diagnosis and therapeutic management. Delayed treatment may cause cardiac and trophic complications. PRESENTATION OF CASES We describe 4 cases of AVFs complicating stab wounds of the lower limb, associated in 2 cases with pseudoaneurysms. DISCUSSION In two cases we performed a surgical repair, whereas in the other 2 patients we choose an endovascular treatment with wall graft stent placement. CONCLUSION All traumatic AVFs must be treated to avoid vascular, local and general complications. Using both techniques, we had great results with no complications.
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Affiliation(s)
- Ayoub Bounssir
- Vascular Surgery Departement, Ibn Sina University Hospital Center, 10104, Souissi, Rabat, Morocco; Université Mohammed V, faculté de médecine et de pharmacie de Rabat, Morocco.
| | - Houda Taghi
- Vascular Surgery Departement, Ibn Sina University Hospital Center, 10104, Souissi, Rabat, Morocco; Université Mohammed V, faculté de médecine et de pharmacie de Rabat, Morocco
| | - Nabil Sedki
- Vascular Surgery Departement, Ibn Sina University Hospital Center, 10104, Souissi, Rabat, Morocco; Université Mohammed V, faculté de médecine et de pharmacie de Rabat, Morocco
| | - Tarik Bakkali
- Vascular Surgery Departement, Ibn Sina University Hospital Center, 10104, Souissi, Rabat, Morocco; Université Mohammed V, faculté de médecine et de pharmacie de Rabat, Morocco
| | - Brahim Lekehal
- Vascular Surgery Departement, Ibn Sina University Hospital Center, 10104, Souissi, Rabat, Morocco; Université Mohammed V, faculté de médecine et de pharmacie de Rabat, Morocco
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29
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Daou BJ, Pandey AS. Commentary: Access-Site Complications in Transfemoral Neuroendovascular Procedures: A Systematic Review of Incidence Rates and Management Strategies. Oper Neurosurg (Hagerstown) 2020; 19:E335-E336. [PMID: 32392292 DOI: 10.1093/ons/opaa127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/17/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Badih J Daou
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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30
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Minici R, Paone S, Talarico M, Zappia L, Abdalla K, Petullà M, Laganà D. Percutaneous treatment of vascular access-site complications: a ten years' experience in two centres. CVIR Endovasc 2020; 3:29. [PMID: 32507937 PMCID: PMC7276472 DOI: 10.1186/s42155-020-00120-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background The spread of percutaneous arterial catheterization in diagnostic and therapeutic procedures has led to a parallel increase of vascular access site complications. The incidence of these events is between 0.2–1%. A detailed analysis of injuries by type of procedure shows a higher incidence of injuries after therapeutic procedures (3%) than those observed for diagnostic ones (1%), due to the greater size of the vascular devices used and the necessity to frequently administer anticoagulant and antiplatelet therapy during procedures. The iatrogenic arterial injuries requiring treatment are the pseudoaneurysm, arteriovenous fistula, arterial rupture and dissection. Less frequent complications include distal embolization of the limbs, nerve damage, abscess and lymphocele. Moreover, the use of percutaneous vascular closure devices (VCD) has further expanded the types of complications, with an increased risk of stenosis, thrombosis, distal embolism and infection. Our work aims to bring the personal 10 years’ experience in the percutaneous treatment of vascular access-site complications. Results Ninety-two pseudoaneurysms (PSA), 12 arteriovenous fistulas (AVF), 15 retrograde dissections (RD) and 11 retroperitoneal bleedings (RB) have been selected and treated. In 120/130 cases there were no periprocedural complications with immediate technical success (92.3%). Nine femoral PSA, treated with percutaneous ultrasound-guided thrombin injection, showed a failure to close the sac and therefore they were treated by PTA balloon inflation with a contralateral approach and cross-over technique. Only one case of brachial dissection, in which the prolonged inflation of the balloon has not led to a full reimbursement of the dissection flap, was then surgically repaired. At the 7 days follow-up, complications were two abscesses in retroperitoneal bleedings, treated by percutaneous drainage. At 3 months, acute occlusion of 3 covered femoral stents occurred, then treated by loco-regional thrombolysis and PTA. A total of 18 major complications was recorded at 2 years, with a complication rate at 2 years of 13.8%. Conclusions The percutaneous treatment of vascular access-site complications is the first-choice treatment. It represents a safe and effective option, validated by a high technical success rate and a low long-term complication rate, that allows avoiding the surgical approach in most cases.
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Affiliation(s)
- Roberto Minici
- Radiology Division, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Viale Europa, 88100, Catanzaro, CZ, Italy.
| | - Sara Paone
- IRC - FSH, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Marisa Talarico
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Lorenzo Zappia
- Radiology Division, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Viale Europa, 88100, Catanzaro, CZ, Italy
| | - Karim Abdalla
- Anaesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Catanzaro, Italy
| | - Maria Petullà
- Radiology Division, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Viale Europa, 88100, Catanzaro, CZ, Italy
| | - Domenico Laganà
- Radiology Division, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Viale Europa, 88100, Catanzaro, CZ, Italy.,Radiology Division, University of Insubria, Varese, Italy
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31
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Oneissi M, Sweid A, Tjoumakaris S, Hasan D, Gooch MR, Rosenwasser RH, Jabbour P. Access-Site Complications in Transfemoral Neuroendovascular Procedures: A Systematic Review of Incidence Rates and Management Strategies. Oper Neurosurg (Hagerstown) 2020; 19:353-363. [DOI: 10.1093/ons/opaa096] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 02/10/2020] [Indexed: 01/05/2023] Open
Abstract
Abstract
BACKGROUND
The femoral artery is the most common access route for cerebral angiography and neurointerventional procedures. Complications of the transfemoral approach include groin hemorrhages and hematomas, retroperitoneal hematomas, pseudoaneurysms, arteriovenous fistulas, peripheral artery occlusions, femoral nerve injuries, and access-site infections. Incidence rates vary among different randomized and nonrandomized trials, and the literature lacks a comprehensive review of this subject.
OBJECTIVE
To gather data from 16 randomized clinical trials (RCT) and 17 nonrandomized cohort studies regarding femoral access-site complications for a review paper. We also briefly discuss management strategies for these complications based on the most recent literature.
METHODS
A PubMed indexed search for all neuroendovascular clinical trials, retrospective studies, and prospective studies that reported femoral artery access-site complications in neurointerventional procedures.
RESULTS
The overall access-site complication rate in RCTs is 5.13%, while in in non-RCTs, the rate is 2.78%. The most common complication in both groups is groin hematoma followed by access-site hemorrhage and femoral pseudoaneurysm. On the other hand, wound infection was the least common complication.
CONCLUSION
The transfemoral approach in neuroendovascular procedures holds risk for several complications. This review will allow further studies to compare access-site complications between the transfemoral approach and other alternative access sites, mainly the transradial approach, which is gaining a lot of interest nowadays.
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Affiliation(s)
- Mazen Oneissi
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas
| | - Ahmad Sweid
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Stavropoula Tjoumakaris
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - David Hasan
- Department of Neurosurgery, University of Iowa, Iowa, Iowa
| | - M Reid Gooch
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Robert H Rosenwasser
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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Lederman RJ, Babaliaros VC, Rogers T, Stine AM, Chen MY, Muhammad KI, Leonardi RA, Paone G, Khan JM, Leshnower BG, Thourani VH, Tian X, Greenbaum AB. The Fate of Transcaval Access Tracts: 12-Month Results of the Prospective NHLBI Transcaval Transcatheter Aortic Valve Replacement Study. JACC Cardiovasc Interv 2020; 12:448-456. [PMID: 30846083 DOI: 10.1016/j.jcin.2018.11.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The authors investigated 1-year outcomes after transcaval access and closure for transcatheter aortic valve replacement (TAVR), using commercially available nitinol cardiac occluders off-label. BACKGROUND Transcaval access is a fully percutaneous nonfemoral artery route for TAVR. The intermediate-term fate of transcaval access tracts is not known. METHODS The authors performed a prospective, multicenter, independently adjudicated trial of transcaval access, using Amplatzer nitinol cardiac occluders (Abbott Vascular, Minneapolis, Minnesota), among subjects without traditional transthoracic (transapical or transaortic) access options. One-year clinical follow-up included core laboratory analysis of serial abdominal computed tomography (CT). RESULTS 100 subjects were enrolled. Twelve-month mortality was 29%. After discharge, there were no vascular complications of transcaval access. Among 83 evaluable CT scans after 12 months, 77 of fistulas (93%) were proven occluded, and only 1 was proven patent. Fistula patency was not associated with overall survival (p = 0.37), nor with heart failure admissions (15% if patent vs. 23% if occluded; p = 0.30). There were no cases of occluder fracture or migration or visceral injury. CONCLUSIONS Results are reassuring 1 year after transcaval TAVR and closure using permeable nitinol occluders off-label. There were no late major vascular complications. CT demonstrated spontaneous closure of almost all fistulas. Results may be different in a lower-risk cohort, with increased operator experience, and using a dedicated transcaval closure device. (Transcaval Access for Transcatheter Aortic Valve Replacement in People With No Good Options for Aortic Access; NCT02280824).
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Affiliation(s)
- Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood institute, National Institutes of Health, Bethesda, Maryland.
| | | | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood institute, National Institutes of Health, Bethesda, Maryland; Medstar Heart and Valve Institute, Medstar Washington Hospital Center, Washington, DC
| | - Annette M Stine
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood institute, National Institutes of Health, Bethesda, Maryland
| | - Marcus Y Chen
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood institute, National Institutes of Health, Bethesda, Maryland
| | | | | | - Gaetano Paone
- Henry Ford Hospital, Center for Structural Heart Disease, Detroit, Michigan
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood institute, National Institutes of Health, Bethesda, Maryland
| | | | - Vinod H Thourani
- Emory University Structural Heart and Valve Center, Atlanta, Georgia; Medstar Heart and Valve Institute, Medstar Washington Hospital Center, Washington, DC
| | - Xin Tian
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, Maryland
| | - Adam B Greenbaum
- Emory University Structural Heart and Valve Center, Atlanta, Georgia; Henry Ford Hospital, Center for Structural Heart Disease, Detroit, Michigan
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33
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Mazzaccaro D, Occhiuto MT, Avishay DM, Modafferi A, Righini P, Malacrida G, Nano G. A Unique Case of Iatrogenic Femoral Arteriovenous Fistula associated with Deep Vein Thrombosis after Electrophysiological Procedure in a Kidney Transplanted Patient. Ann Vasc Surg 2020; 65:282.e5-282.e8. [DOI: 10.1016/j.avsg.2019.11.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022]
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34
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Stathis A, Gan J. Traumatic arteriovenous fistula: a 25-year delay in presentation. J Surg Case Rep 2020; 2020:rjaa042. [PMID: 32226601 PMCID: PMC7092680 DOI: 10.1093/jscr/rjaa042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/10/2020] [Accepted: 02/18/2020] [Indexed: 11/12/2022] Open
Abstract
A 64-year-old lady presented with a 6-month history of worsening unilateral leg swelling, with an audible bruit of the popliteal artery. Arterial duplex ultrasound confirmed the presence of an arteriovenous fistula (AVF) between the posterior tibial artery and vein. Upon thorough history, it was discovered that the patient had sustained a stab wound to this region some 25 years prior. The fistula was successfully managed endovascularly by means of a covered stent. This case highlights an unusual delayed presentation of an AVF and demonstrates the effectiveness of endovascular treatment of this condition.
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Affiliation(s)
- Alexandra Stathis
- Department of Surgery, Port Macquarie Base Hospital, Port Macquarie NSW Australia
- Correspondence address. Department of Surgery Port Macquarie Base Hospital, Wrights Rd, Port Macquarie, NSW 2444, Australia Tel: (02) 5524 2000; E-mail:
| | - John Gan
- Department of Surgery, Port Macquarie Base Hospital, Port Macquarie NSW Australia
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35
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Kim JS, Lee SA, Chee HK, Hwang JJ, Kim HY, Kim JY, Choi SM, Kim YH, Lee WS. Femoral arteriovenous fistula associated with surgery of proximal femoral fracture: a systematic review of the literature and case presentation. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:291. [PMID: 32355735 PMCID: PMC7186609 DOI: 10.21037/atm.2020.03.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Proximal femoral fracture (PFF), such as intertrochanteric femoral fracture or femur neck fracture, and its management are crucial issues to surgeons. PFF has been dramatically is becoming exponentially prevalent, and it is at high risk of complication and mortality because it is frequently associated with serious trauma and advanced age, especially in patients treated with anticoagulants or antiplatelet agents. Surgical management is essential for the treatment of PFF. Unfortunately, current surgical procedures have been related to accompanied by vascular complications, including laceration, hemorrhage, thrombosis, embolism, intimal flap tear and pseudoaneurysm. Furthermore, these vascular injuries following surgical management of PFF are potentially limb- and life-threatening. Of the complications after operation of PFF, femoral arteriovenous fistula (AVF) is rare, but remains a challenging problem because it is frequently associated with significantly high mortality and morbidity and is very difficult to treat. Methods A systematic literature review was conducted using the PRISMA guidelines with no language restriction. We searched scientific publications via PubMed, Embase, Cochrane central register of controlled trial, Google Scholar, the KoreaMed and the Research Information Sharing Service database. The goal of this study was to report on the incidence, clinical presentation, diagnosis, treatment, associated complications, morbidity and mortality of femoral AVF caused by PFF and to draw special attention to its prevention and management. Results A total of 7 case reports on femoral AVF associated with operation of PFF were identified, and one our case was added to the systematic analysis. Of the 8 cases, 4 were male and 4 were female under the age of 67.87±18.44; 6 (75.0%) survived without any events, 1 (12.5%) survived with a sequela of peroneal nerve impairment, and 1 (12.5%) died of multi-organ failure and hypovolemia. Conclusions The incidence of femoral AVF associated with PFF is extremely low, though it appears to increase with the rising frequency of PFF. With a very few exceptions, complications following internal fixation are potentially limb- and life-threatening. There is still no definite consensus on the standardized diagnostic or therapeutic modalities. Therefore, surgeons should keep in mind that this serious complication requires early diagnosis and prompt treatment, which should not be underestimated. Femoral AVF following operation of PFF should be meticulously managed, because untreated fistulae result in serious unexpected complications including renin-mediated hypertension, high-output heart failure and venous and/or arterial insufficiency. Surgical treatment is still the gold standard for such cases, but in limited cases endovascular procedures using embolization and closure device can be a good treatment option.
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Affiliation(s)
- Jun Seok Kim
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Konkuk University Seoul Hospital, Seoul, Republic of Korea
| | - Song Am Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Konkuk University Seoul Hospital, Seoul, Republic of Korea
| | - Hyun Keun Chee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Konkuk University Seoul Hospital, Seoul, Republic of Korea
| | - Jae Joon Hwang
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Konkuk University Seoul Hospital, Seoul, Republic of Korea
| | - Hye Young Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju-si, Chungbuk, Republic of Korea
| | - Jin Yong Kim
- Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju-si, Chungbuk, Republic of Korea
| | - Seung Myung Choi
- Department of Orthopedic Surgery, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju-si, Chungbuk, Republic of Korea
| | - Yo Han Kim
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju-si, Chungbuk, Republic of Korea
| | - Woo Surng Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju-si, Chungbuk, Republic of Korea
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36
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Shah SR, Kiemeneij F, Khuddus MA. Distal arteriovenous fistula formation after percutaneous coronary intervention: An old complication of a new access site. Catheter Cardiovasc Interv 2020; 97:278-281. [DOI: 10.1002/ccd.28772] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 01/02/2020] [Accepted: 01/29/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Syed Raza Shah
- North Florida Regional Medical Center University of Central Florida Gainesville Florida
| | | | - Matheen A. Khuddus
- North Florida Regional Medical Center University of Central Florida Gainesville Florida
- The Cardiac and Vascular Institute Gainesville Florida
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37
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Yamamoto Y, Uchiyama H, Onuki M. An Unusual Variational Anatomy of the Medial Circumflex Femoral Artery: A Case Report of a Post-catheterization Femoral Arteriovenous Fistula. Cureus 2020; 12:e6734. [PMID: 32133257 PMCID: PMC7034769 DOI: 10.7759/cureus.6734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The medial circumflex femoral artery (MCFA) typically presents as a major branch of the profunda femoris artery or it can also directly originate from the common femoral artery. Many anatomical variations of the MCFA have been described due to their clinical significance. We herein report a case of an unusual anatomical variation of the MCFA crossing anterior to the femoral vein that led to iatrogenic arteriovenous fistula formation after cardiac catheterization. The identification of such rare vascular anatomical variations is of great importance when attempting femoral arterial or venous puncture in order to minimize unnecessary complications.
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Affiliation(s)
- Yohei Yamamoto
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, JPN
| | - Hidetoshi Uchiyama
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, JPN
| | - Masahiro Onuki
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, JPN
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38
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Testi G, Grotti S, Ceccacci T, Tarantino F, Turicchia GU. Arteriovenous Fistula of the Peroneal Artery Complicating a Retrograde Access: Successful Endovascular Treatment with Covered Stent Implantation. Ann Vasc Surg 2019; 64:410.e1-410.e6. [PMID: 31639478 DOI: 10.1016/j.avsg.2019.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/22/2019] [Accepted: 10/01/2019] [Indexed: 11/24/2022]
Abstract
An 80-year-old woman developed a recurrent chronic limb-threatening ischemia of the right lower limb after a popliteal artery (PA) recanalization with retrograde puncture of the peroneal artery (PR). The angiography showed the PA restenosis and an arteriovenous fistula (AVF) at the previous peroneal retrograde access site. After the PA angioplasty, the AVF was identified through selective contrast injections in multiple projections. A coronary balloon-expandable covered stent was deployed at the AVF site with complete resolution of the AVF. The final angiography demonstrated the patency of PA and PR with complete resolution of the AVF. The patient was discharged without complications, with regression of rest pain. The foot lesion healed within 2 months.
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Affiliation(s)
- Gabriele Testi
- Cardiovascular Department, AUSL Romagna, Forlì-Cesena Vascular Surgery Unit, Morgagni-Pierantoni Hospital, Forlì (FC), Italy.
| | - Simone Grotti
- Cardiovascular Department, AUSL Romagna, Interventional Cardiology, Morgagni-Pierantoni Hospital, Forlì (FC), Italy
| | - Tanja Ceccacci
- Cardiovascular Department, AUSL Romagna, Forlì-Cesena Vascular Surgery Unit, Morgagni-Pierantoni Hospital, Forlì (FC), Italy
| | - Fabio Tarantino
- Cardiovascular Department, AUSL Romagna, Interventional Cardiology, Morgagni-Pierantoni Hospital, Forlì (FC), Italy
| | - Giorgio Ubaldo Turicchia
- Cardiovascular Department, AUSL Romagna, Forlì-Cesena Vascular Surgery Unit, Morgagni-Pierantoni Hospital, Forlì (FC), Italy
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39
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Sahashi Y, Takasugi N, Yanagimoto TS, Endo S, Nakashima T, Okura H. Arteriovenous femoral fistula after insertion of leadless pacemaker-A case with an anomaly of the deep femoral artery. J Arrhythm 2019; 35:770-772. [PMID: 31624520 PMCID: PMC6787157 DOI: 10.1002/joa3.12224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/16/2019] [Accepted: 07/28/2019] [Indexed: 11/21/2022] Open
Abstract
With the increasing number of implanted leadless pacemakers, complications related to the implantation procedure are being reported. We herein report a case of an 87-year-old male with an arteriovenous fistula after leadless pacemaker implantation due to an anomaly of the right deep femoral artery (DFA). In this present case, a right DFA arising from the antero-medial side of the main femoral artery was attributed to this complication.
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Affiliation(s)
- Yuki Sahashi
- Department of Cardiology, Graduate School of MedicineGifu UniversityGifuJapan
| | - Nobuhiro Takasugi
- Department of Cardiology, Graduate School of MedicineGifu UniversityGifuJapan
| | | | - Susumu Endo
- Department of Cardiology, Graduate School of MedicineGifu UniversityGifuJapan
| | - Takashi Nakashima
- Department of Cardiology, Graduate School of MedicineGifu UniversityGifuJapan
| | - Hiroyuki Okura
- Department of Cardiology, Graduate School of MedicineGifu UniversityGifuJapan
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40
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Yan GW, Li HW, Yang GQ, Bhetuwal A, Liu JP, Li Y, Fu QS, Zhao LW, Chen H, Hu N, Wu L, Yan J, Wang W, Shuang JY, Ge J. Iatrogenic arteriovenous fistula of the iliac artery after lumbar discectomy surgery: a systematic review of the last 18 years. Quant Imaging Med Surg 2019; 9:1163-1175. [PMID: 31367570 DOI: 10.21037/qims.2019.05.12] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients with iatrogenic iliac arteriovenous fistulas (IAVFs) after lumbar discectomy surgeries (LDSs) from our hospital and the published literature were reviewed in order to better understand this clinical phenomenon. Literature from databases about iatrogenic IAVFs after LDSs were retrieved and a patient from our hospital was reviewed with emphasis placed upon the patient's clinical data. From 31 publications and studies of 44 individuals' data, the study revealed L4-L5 and/or L5-S1 intervertebral space levels were mostly involved (62.0%). Most of the patients underwent computed tomography angiography (CTA) and/or digital subtraction angiography (DSA) examinations to confirm the potential diagnosis and rule out other differential diagnosis (86.4%). Most of the patients (63.6%) developed features of high output heart failure months to years after the LDSs, and the majority of them (88.6%) were treated with endovascular repairs. An iatrogenic IAVF after an LDS is a rare occurrence; however, more attention should be paid to it for the purpose of obtaining accurate diagnosis and proper treatment.
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Affiliation(s)
- Gao-Wu Yan
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Hong-Wei Li
- Department of Radiology, The Third Hospital of Mianyang (Sichuan Mental Health Center), Mianyang 621000, China
| | - Guo-Qing Yang
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Anup Bhetuwal
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Jian-Ping Liu
- Department of Cardiovascular Surgery, Suining Central Hospital, Suining 629000, China
| | - Yong Li
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Quan-Shui Fu
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Lin-Wei Zhao
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Hong Chen
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Na Hu
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Lei Wu
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Jing Yan
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Wei Wang
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Jiao-Yue Shuang
- Department of Radiology, Suining Central Hospital, Suining 629000, China.,Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Jing Ge
- Department of Cardiovascular Surgery, Suining Central Hospital, Suining 629000, China
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41
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Papes D, Šnajdar I, Ćavar S, Antabak A, Bulić K, Bartoniček D, Dobrota S, Luetić T. Pediatric Iatrogenic Arteriovenous Fistulas. Am Surg 2019. [DOI: 10.1177/000313481908500512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Dino Papes
- Department of Pediatric Surgery University Hospital Centre Zagreb Zagreb, Croatia
| | - Irena Šnajdar
- Department of Pediatric Surgery University Hospital Centre Zagreb Zagreb, Croatia
| | - Stanko Ćavar
- Department of Pediatric Surgery University Hospital Centre Zagreb Zagreb, Croatia
| | - Anko Antabak
- Department of Pediatric Surgery University Hospital Centre Zagreb Zagreb, Croatia
| | - Kresimir Bulić
- Department of Pediatric Surgery University Hospital Centre Zagreb Zagreb, Croatia
| | - Dorotea Bartoniček
- Department of Pediatric Cardiology University Hospital Centre Zagreb Zagreb, Croatia
| | - Savko Dobrota
- Department of Radiology University Hospital Centre Zagreb Zagreb, Croatia
| | - Tomislav Luetić
- Department of Pediatric Surgery University Hospital Centre Zagreb Zagreb, Croatia
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42
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Işık M, Tanyeli Ö, Dereli Y, Taban VB, Altınbaş Ö, Görmüş N. Gradual Treatment of Arteriovenous Fistula in Femoral Vessels as a Complication of Coronary Angiography. Braz J Cardiovasc Surg 2019; 33:631-633. [PMID: 30652754 PMCID: PMC6326445 DOI: 10.21470/1678-9741-2018-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/09/2018] [Indexed: 11/30/2022] Open
Abstract
Arteriovenous fistula due to coronary angiography intervention is rarely seen.
Arteriovenous fistulas may be asymptomatic according to the size of the shunt,
as well as to the heart failure. In this case report, we aimed to share gradual
transition from endovascular methods to surgery and why surgical treatment is
required for a patient who developed arteriovenous fistula after coronary
angiography.
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Affiliation(s)
- Mehmet Işık
- Department of Cardiovascular Surgery, Necmettin Erbakan University, Meram Medicine Faculty, Konya, Turkey
| | - Ömer Tanyeli
- Department of Cardiovascular Surgery, Necmettin Erbakan University, Meram Medicine Faculty, Konya, Turkey
| | - Yüksel Dereli
- Department of Cardiovascular Surgery, Necmettin Erbakan University, Meram Medicine Faculty, Konya, Turkey
| | - Volkan Burak Taban
- Department of Cardiovascular Surgery, Necmettin Erbakan University, Meram Medicine Faculty, Konya, Turkey
| | - Özgür Altınbaş
- Department of Cardiovascular Surgery, Training and Research Hospital, Konya, Turkey
| | - Niyazi Görmüş
- Department of Cardiovascular Surgery, Necmettin Erbakan University, Meram Medicine Faculty, Konya, Turkey
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43
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Gandhi J, Zaidi S, Suh Y, Joshi G, Smith NL, Ali Khan S. An index of inguinal and inguinofemoral masses in women: Critical considerations for diagnosis. TRANSLATIONAL RESEARCH IN ANATOMY 2018. [DOI: 10.1016/j.tria.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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44
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Means G, End C, Kaul P. Management of Percutaneous Coronary Intervention Complications. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:25. [DOI: 10.1007/s11936-017-0526-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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Cabezuelo Adame X, Vega de Ceniga M, Aramendi Arietaaraunabeña C, Cabrera A, Saralegui I. Fístulas arteriovenosas de los troncos supraaórticos. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2015.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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46
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Low rate of access site complications after transradial coronary catheterization: A prospective ultrasound study. IJC HEART & VASCULATURE 2016; 14:46-52. [PMID: 28616563 PMCID: PMC5454178 DOI: 10.1016/j.ijcha.2016.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/17/2016] [Accepted: 12/16/2016] [Indexed: 01/16/2023]
Abstract
Background Transradial artery (TRA) left heart catheterization is an increasingly used technique for both diagnostic and interventional coronary procedures. This study evaluates the incidence of access site complications in the current interventional era. Methods and results A total of 507 procedures were performed under standardized conditions. Each procedure was performed using high levels of anticoagulation, hydrophilic sheaths, and short post-procedural compression times. Vascular complications were assessed one day after TRA catheterization using Duplex sonography and classified according to the necessity of additional medical intervention. A simple questionnaire helped identifying upper extremity neurologic or motor complications. Vascular complications were detected in 12 patients (2.36%): radial artery occlusion was detected in 9 patients (1.77%), 1 patient developed an AV-fistula (0.19%), and 2 patients had pseudoaneurysms (0.38%). None of the patients required specialized medical or surgical intervention. Under our procedural conditions, small radial artery diameter was the only significant predictor for the development of post-procedural vascular complications (2.11 ± 0.42 mm vs 2.52 ± 0.39 mm, p = 0.001). None of the previously reported risk factors, namely, advanced renal failure, diabetes, acuteness/complexity of procedure, or sheath and catheter size significantly influenced the rate of vascular complications. No major hematoma or local neurologic or motor complications were identified. Conclusions Using current techniques and materials, we report a very low rate of local complications associated with TRA catheterization.
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Clot injection for treatment of iatrogenic femoral arteriovenous fistula after percutaneous coronary intervention: a novel minimally invasive method. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:364-367. [PMID: 27980552 PMCID: PMC5133326 DOI: 10.5114/aic.2016.63638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/28/2016] [Indexed: 12/02/2022] Open
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Yadav P, Nunia SK, Singh D, Lal H. Asymptomatic posthaemodialysis femoral arteriovenous fistula: multidetector computed tomography (MDCT) evaluation and management. BMJ Case Rep 2016; 2016:bcr-2016-216947. [PMID: 27507696 DOI: 10.1136/bcr-2016-216947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Priyank Yadav
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sandeep Kumar Nunia
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Dharamveer Singh
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Hira Lal
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Lamb K. Pseudoaneurysm and Arteriovenous Fistula Simultaneously After Cardiac Catheterization. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479307304110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pseudoaneurysms and arteriovenous fistulas are rare complications associated with cardiac catheterization. A patient presented with atrial fibrillation after cardiac catheterization was performed one month prior. A sonogram was ordered due to leg swelling and an audible bruit in the right groin. The sonogram showed findings that were consistent with a pseudoaneurysm and arteriovenous fistula in this region. To obtain clinical correlation, an arteriogram was performed confirming these findings. A covered stent was implanted for treatment, which showed excellent results in a follow-up arteriogram and sonogram. Sonography served as an excellent modality in the evaluation and diagnosis in this case.
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Affiliation(s)
- Kandy Lamb
- Diagnostic Medical Sonography Program of Denver, Aurora, CO,
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Acute Deep Vein Thrombosis in Venous Aneurysm following Closure of the Chronic Traumatic Arteriovenous Fistulae of the Lower Extremities. Case Rep Surg 2016; 2016:1375214. [PMID: 27293948 PMCID: PMC4887620 DOI: 10.1155/2016/1375214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/04/2016] [Indexed: 11/20/2022] Open
Abstract
Chronic traumatic arteriovenous fistula (AVF) commonly results from an unrecognized vascular injury. In this report, there were two cases of chronic traumatic AVF of the legs with a long history of stab (case 1) and shotgun wounds (case 2). Both cases presented with varicose veins together with hyperpigmentation around the ankle of the affected leg. Angiograms showed a single large AVF in case 1, whereas, in case 2, there was a single large AVF together with multiple small AVFs. In both cases large venous aneurysm was found next to a large AVF. An open surgical AVF closure for the large AVF was performed in case 1 successfully, but patient developed acute deep vein thrombosis (DVT) in a large venous aneurysm. In the second case, in order to prevent DVT, only closure of the large AVF was performed, which preserved arterial flow into the venous aneurysm. Case 2 did not have acute DVT. This report raised the concern about acute DVTs in venous aneurysms following the closure of chronic traumatic AVF in terms of prevention. Also chronic traumatic AVF is commonly due to misdiagnosis in the initial treatment, so complete and serial physical examinations in penetrating vascular injury patients are of paramount importance.
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