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Arteriovenous fistula as a complication of transradial coronary angiography: a case report
Dehghani Payam,Culig Jennifer,Patel Darshan,Kraushaar Greg
Journal of Medical Case Reports , 2013, DOI: 10.1186/1752-1947-7-21
Abstract: Introduction Iatrogenic arteriovenous fistula is a vascular condition that may result from coronary angiography. Many case reports have described arteriovenous fistula occurrence after coronary angiography using the transfemoral access route, but rarely as a complication of using the transradial approach. We report a rare case of a patient with arteriovenous fistula following transradial artery coronary angiography. Case presentation A 62-year-old Caucasian man underwent emergent coronary angiography using the right radial artery approach. One month after angiography, he discovered a turbulent sound near the access site. A right radial arteriovenous fistula was found upon duplex ultrasound investigation. The patient was treated conservatively. At 1-year follow-up, the arteriovenous fistula was unchanged and the patient remained hemodynamically stable and asymptomatic. Conclusion Iatrogenic arteriovenous fistula is a rare vascular complication of transradial artery coronary angiography. The natural history of arteriovenous fistula is benign and is thought to resolve spontaneously; therefore, a conservative approach, as opposed to surgical ligation, is recommended as the first-line treatment.
Coronary Arteriovenous Fistula Secondary to Percutaneous Coronary Intervention of Chronic Total Occlusion  [PDF]
Seshasayee Narasimhan
Case Reports in Vascular Medicine , 2013, DOI: 10.1155/2013/706820
Abstract: This is a case report of a 61-year-old female presenting with ongoing chest pain in the setting of an NSTEMI with lateral ST-T changes. On attempting to open the left circumflex (LCX), it resulted in a proximal LCX dissection. The patient remained stable with no further chest pain. She was treated with IV Eptifibatide for 48 hours and restudied in 72 hours. Repeat coronary angiography showed a marginally improved proximal dissection plane with a coronary AV fistula. She was managed conservatively and discharged with a non-invasive assessment in 8 weeks. The patient had a negative stress echocardiogram and was managed with maximal medical therapy. 1. Introduction Coronary AV fistulae are uncommon and bypass the myocardial capillary network and connect a coronary artery to another vessel or cardiac chamber. The primary etiology of coronary AV fistula is congenital and 0.25% is iatrogenic [1, 2]. Iatrogenic coronary AV fistulas are seen after acute myocardial infarction, aortic valve replacement, coronary angioplasty, coronary artery bypass graft surgery (CABG), endomyocardial biopsies, and thoracic trauma [3–11]. Given that iatrogenic coronary AV fistula is a rare complication, management guidelines are limited. However, there are several case reports discussing treatment options ranging from coil embolization, PTFE stent deployment and surgery [12–14]. 2. Case Report A 61-year-old female presents with a non-ST elevation myocardial infarction (NSTEMI) in the setting of previous percutaneous coronary intervention (PCI) to the right coronary artery (RCA) with a bare metal stent (BMS) in 2004 on a background of treated hypertension and hypercholesterolemia and smoking. Her regular medications were aspirin 81?mg OD, metoprolol 25?mg BID, ramipril 5?mg OD and atorvastatin 40?mg OD. Since admission, she had ongoing chest pain. Her ECG had lateral ST-T changes and the peak cTnI was 3.0?ng/mL. She was brought emergently to the cardiac catheterization laboratory. The procedure was completed via right transradial catheterization. Coronary angiography showed diffusely diseased left anterior descending coronary artery (LAD) with a 70% stenosis in the mid third with an occluded first obtuse marginal coronary artery (OM1) with TIMI 0 flow (Figure 1). The RCA was anterior in origin and nonselective coronary injection showed a patent stent (Figure 2). The OM1 was considered to be the culprit vessel and attempted to cross with Pilot 50 wire (Guidant Corp., Indianapolis, IN, USA). The wire crossed the proximal subsection of the left circumflex (LCX) with support (Abbott
Coronary arteriovenous fistulas in the adults: natural history and management strategies
Yusuf Ata, Tamer Turk, Murat Bicer, Mihriban Yalcin, Filiz Ata, Senol Yavuz
Journal of Cardiothoracic Surgery , 2009, DOI: 10.1186/1749-8090-4-62
Abstract: Eleven adult patients were treated surgically for coronary arteriovenous fistulas (8 male, 3 female) during the last three years. Mean age was 48,7 ± 9,5 years (range 32-65 years). Diagnosis was made by coronary angiography and transesophageal echocardiographyAll patients were symptomatic due to the associating cardiac disorder or fistula. Presenting symptoms were chest pain, exertional dyspnea and palpitation. All patients were diagnosed by selective angiography. Transthoracic and transoesophageal echocardiography was performed to identify the Qp/Qs ratio in one patient. One patient who had an LAD to pulmonary artery coronary arteriovenous fistula with a vascular malformation needed early reoperation due to recurrence of the fistula. Echocardiographic evaluation at the postoperative third month revealed no residual shunts in all patients.Because of the severe complications that may develop due to coronary arteriovenous fistula, we believe that every coronary artery fistula should be treated invasively by surgery or transcatheter closure. But both treatment modalities still need to be evaluated with randomized multicenter studies for long term survival and effectiveness.Coronary arteriovenous fistula (CAVF) is rare anomaly which consists of abnormal communication between coronary artery and one of the cardiac chambers or vessels adjacent to the heart. Coronary arteriovenous fistulas (CAVFs) are present in 0.002% of the general population and are visualized in nearly 0.25% of patients undergoing catheterization [1-5].Most of the patients with CAVFs are older than 20 years. Although they remain asymptomatic, symptoms and complications may develop with increasing age, and when surgery is performed in later life mortality and morbidity is increased [6,7]. We present our experience in eleven adult patients with CAVFs, document diagnostic evaluation and management strategies. The objective of this study was to describe aspects of the natural history and pathophysiology of
Surgical management of a pial arteriovenous fistula with giant varix in an infant  [cached]
Pillai Ashok,Rajeev K,Unnikrishnan M
Neurology India , 2006,
Abstract: A seven-month-old infant presented with a generalized seizure. The radiological evaluation revealed a large arteriovenous fistula in the left sylvian region. The fistula connected the left middle cerebral artery and the vein of Trolard. A giant varix was present at the venous end. The child underwent craniotomy, complete disconnection of the fistula and excision of the varix. Except for recurrent seizures, which were eventually controlled on anticonvulsants, the child′s neurological development has been good on long-term follow-up of three years. Pial arteriovenous fistulae are rare intracranial vascular malformations. Though significant operative risks exist, they can be successfully managed surgically with good long-term prognosis.
Arteriovenous Malformation in Temporal Lobe Presenting as Contralateral Ocular Symptoms Mimicking Carotid-Cavernous Fistula  [PDF]
Fadzillah Mohd-Tahir,Ishak Siti-Raihan,W. H. Wan Hazabbah
Case Reports in Ophthalmological Medicine , 2013, DOI: 10.1155/2013/158961
Abstract: Aim. To report a rare case of arteriovenous malformation in temporal lobe presenting as contralateral orbital symptoms mimicking carotid-cavernous fistula. Method. Interventional case report. Results. A 31-year-old Malay gentleman presented with 2-month history of painful progressive exophthalmos of his left eye associated with recurrent headache, diplopia, and reduced vision. Ocular examination revealed congestive nonpulsating 7?mm exophthalmos of the left eye with no restriction of movements in all direction. There was diplopia in left lateral gaze. Left IOP was elevated at 29?mmHg. Left eye retinal vessels were slightly dilated and tortuous. CT scan was performed and showed right temporal arteriovenous malformation with a nidus of 3.8?cm?×?2.5?cm with right middle cerebral artery as feeding artery. There was dilated left superior ophthalmic vein of 0.9?mm in diameter with enlarged left cavernous sinus. MRA and carotid angiogram confirmed right temporal arteriovenous malformation with no carotid-cavernous fistula. Most of the intracranial drainage was via left cavernous sinus. His signs and symptoms dramatically improved following successful embolisation, completely resolved after one year. Conclusion. Intracranial arteriovenous malformation is rarely presented with primary ocular presentation. Early intervention would salvage the eyes and prevent patients from more disaster morbidity or fatality commonly due to intracranial haemorrhage. 1. Introduction Intracranial arteriovenous malformations (AVMs) are cerebrovascular lesions which consist of networks of arterial and venous channels which communicate directly without any intervening capillary bed. These abnormal communications are divided into two types, plexiform and fistulous. In plexiform type, one or more arterial channels feed a core of tightly venously loop or a nidus, while in the fistulous type, an arterial channel empties directly into a venous channel or the lesion is diffuse with anomalous vessels dispersed among normal brain parenchyma without a nidus. The fistulous types are also known as dural AVMs, which are supplied by meningeal branches of external carotid artery. In contrast, the plexiform type is supplied by branches of the cerebral or cerebellar arteries and therefore also known as pial AVMs. Acquired carotid-cavernous sinus fistula is the most common types of AVM encountered by Ophthalmologist [1]. Patients presented with ocular symptoms resulted from abnormal communication between arterial and venous channels within the cavernous sinus. Ocular symptoms rarely become primary
A Giant Coronary Artery Aneurysm with Coronary Arteriovenous Fistula in Asymptomatic Elderly Patient  [PDF]
Caterina Milici,Daniella Bovelli,Valentino Borghetti,Georgette Khoury,Marco Bazzucchi,Massimo Principi,Marcello Dominici,Enrico Boschetti
Case Reports in Vascular Medicine , 2013, DOI: 10.1155/2013/847972
Abstract: Coronary Arteriovenous Fistula (CAF) is a rare defect that occurs in 0.1-0.2% of patients undergoing coronary angiography; Coronary Artery Aneurism (CAA) also occurs in approximately 15–19% of patients with CAF. It is usually congenital, but in rare occasions it occurs after chest trauma, cardiac surgery, or coronary interventions. The case described is that of a 72-year-old woman, without previous history of cardiovascular disease, who presented a huge cardiac mass. A multimodal approach was necessary to diagnose a giant CAA with CAF responsible for compression and displacement of cardiac structures. Due to likely congenitally origin of the lesion and the absence of symptoms correlated to the CAA and to the CAF we decided to avoid invasive interventions and to treat the patient with medical therapy. 1. Case Report A-72-years old white woman was admitted to our department for recently sudden onset of dyspnea, asthenia, and profuse sweating. At physical examination there were normal hemodynamic parameters (BP 120/80?mmHg, HR 95?bpm), normal SaO2 (97%), and body temperature 36°C. The electrocardiogram (ECG) showed sinus rhythm with morphologically infero-lateral aspecific modification of ventricular repolarization. A wide mediastinal shadow was evidenced at chest X-ray; therefore, the patient was submitted to transthoracic echocardiogram (TTE) which detected an intrapericardial, capsulated mass (max diameter 9?cm) associated with a pericardial effusion (See Supplementary Movie 1 and Movie 2 in Supplementary Material available inline at http://dx.doi.org/10.1155/2013/847972). A better diagnostic mass definition was completed by Transesophageal Echocardiogram (TEE) which showed a calcified regular profiled capsule with concentric areas of a different echogenicity apparently in contiguity with the inferior part of the interatrial septum (Movie 3). The body mass was vacuolated inside with central swirling slow flow. No hemodynamic alteration was induced by the mass due to compression or dislocation of surrounding cardiac structures. Both of the two atria were morphologically normal except for a patent oval foramen. Coronary sinus was not clearly detectable. Both ventricles showed normal dimensions and function. A 16-sliced contrast-enhanced Multidetector Computed Tomography (MDCT) allowed identifying the extracardiac location of the giant capsulated mass, placed between the left ventricle and left atrium. Anatomical structure was composed of a camera of two layers of stratified calcific shells internally coated by a thick organized thrombus containing a
Iatrogenic Aortocoronary Arteriovenous Fistula following Coronary Artery Bypass Surgery: A Case Report and Complete Review of the Literature  [PDF]
Jonathan D. Gardner,William R. Maddox,Joe B. Calkins Jr.
Case Reports in Cardiology , 2012, DOI: 10.1155/2012/652086
Abstract: The case of a patient who presented with angina following a coronary artery bypass (CABG) operation during which the left internal mammary artery was inadvertently anastomosed to a cardiac vein is presented. The literature concerning previously reported cases of aortocoronary arteriovenous fistulas (ACAVF) due to inadvertent grafting of a coronary vein is reviewed and the significance of this complication is discussed. ACAVF due to inadvertent grafting of a coronary vein is a rare complication of CABG and may be a more common cause of graft failure than has previously been recognized. Distortion of cardiac anatomy, the presence of epicardial fat, and an intramyocardial course of the artery intended for grafting are predisposing factors. Some patients present with angina pectoris and heart failure whereas others have no symptoms. The diagnostic test of choice is coronary angiography. Cardiac MRI and CT have a limited role due to the smaller size and the more clearly defined course of these fistulas. Asymptomatic patients are simply observed since spontaneous closure of these fistulas is reported. Symptomatic patients can be treated with combined medical management and percutaneous methods. 1. Introduction Iatrogenic aortocoronary arteriovenous fistula (ACAVF) resulting from placement of an arterial graft to a cardiac vein is a rare complication of CABG. We present a case involving grafting of the left internal mammary artery (LIMA) to a left coronary vein and a review of the literature. 2. Patient Presentation The patient is a 69-year-old male with hypertension, hyperlipidemia, and type 2 diabetes mellitus who presented with exertional chest pain, dyspnea, decreased functional capacity and occasional palpitations. A myocardial perfusion study one month earlier had demonstrated inferolateral ischemia and preserved left ventricular systolic function (EF 69%). Subsequent left heart catheterization (LHC) showed 70% ostial left main stenosis (Figure 1), 60% left anterior descending artery (LAD) stenosis, and complete occlusion of the mid circumflex artery with filling via right to left collaterals. The right coronary artery (RCA) had 70% stenosis in its midportion and left ventricular systolic function was normal. He underwent CABG with the following grafts: LIMA to the LAD, SVG to OM, and SVG to the PDA. Postoperative course was uncomplicated. Figure 1: Left anterior oblique view of the left coronary artery. A JL4 catheter is seen engaging the left coronary artery. The ostial left main is tapered and has a 70% stenosis. Three months later, the patient
A Case Report of Coronary Arteriovenous Fistulas with an Unruptured Coronary Artery Aneurysm Successfully Treated by Surgery
Nobuhiro Takeuchi,Masanori Takada,Yoshiharu Nishibori,Takao Maruyama
Case Reports in Cardiology , 2012, DOI: 10.1155/2012/314685
Abstract: A 58-year-old female with a history of Wolff-Parkinson-White syndrome presented at our institution with palpitations and chest pain. Electrocardiography revealed paroxysmal supraventricular tachycardia with a heart rate of 188 beats/min. Antiarrhythmic drugs were ineffective, and tachycardia was resolved by electrical cardioversion. Transthoracic echocardiography revealed abnormal vessels around the right coronary artery (RCA) and pulmonary artery (PA); in addition, we suspected coronary arteriovenous fistula (CAVF). Coronary angiography and coronary computed tomography revealed dilated fistula vessels, with a 1 cm saccular aneurysm around the RCA, originating from the proximal RCA and left anterior descending artery into the main trunk of PA. Therefore, we confirmed the diagnosis of CAVF with an unruptured aneurysm. We surgically ligated and clipped the fistula vessels and resected the aneurysm. The resected aneurysm measured  cm in size. Pathological examination of the resected aneurysm revealed hypertrophic walls comprising proliferating fibroblasts cells thin elastic fibers. Very few atherosclerotic changes manifested in the aneurysm walls. We report the case of a patient with CAVF and an unruptured coronary artery aneurysm who was successfully treated by surgery.
A Rare Case of Coronary Cameral Fistula from Left Circumflex Artery Draining into the Left Ventricular Apex Presenting as Angina Pectoris: A Case Report  [PDF]
Manish Pendse, Nilesh Walke, Monika Jawanjal, Ghanashyam Kane
World Journal of Cardiovascular Diseases (WJCD) , 2016, DOI: 10.4236/wjcd.2016.67021
Abstract: Coronary cameral fistula (CCF) is a very rare coronary anomaly in which a communication exists between one of the coronaries and a cardiac chamber. Most of the times it is an incidental finding detected at the time of a coronary angiography. However, sometimes it can have serious presentation like unstable angina, coronary steal or ventricular arrhythmia. We present a rare case of coronary cameral fistula arising from left circumflex artery (LCx) draining in to left ventricular (LV) apex and presenting as unstable angina.
Delayed post-surgical development of dural arteriovenous fistula after cervical meningocele repair  [cached]
Flannery T,Tan M,Flynn P,Choudhari K
Neurology India , 2003,
Abstract: A 34-year-old female patient presented with an intracranial subarachnoid hemorrhage and was found to have a dural arteriovenous fistula at the site of previous cervical meningocele repair. Subsequent occlusion was achieved with endovascular embolization. To our knowledge, the phenomenon of the development of a spinal dural fistula at the site of a meningocele repair has not been recorded before.
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