A 39-year-old patient presented with a history of right-side heart failure (dyspnea and orthopnea), right lower extremity deep vein thrombosis, and hepatic impairment. A physical exam showed increased jugular venous pressure, hepatomegaly, and bilateral lower limb pitting edema. A computed tomography angiograph revealed an arteriovenous communication between the right iliac artery and inferior vena cava (IVC) at the level of L4/L5. The patient was diagnosed with a large arteriovenous fistula (AVF), which developed post lumbar disc surgery. Fistulas between the common iliac arteries and IVC are very rare post lumbar disc surgery. Acquired iliocaval AVF is much more difficult to treat surgically because of the risk of massive hemorrhage. The patient underwent a successful endovascular stent graft repair. The patient’s symptoms of heart failure including exertional dyspnea and orthopnea were resolved 6 months post surgery.
Ischemic stroke following cardiac surgery is one of the devastating complications that surgeons may encounter, and may lead to serious disabilities for the patient. The clinical course of such a complication may be prolonged if it is not treated properly. Making a quick decision when choosing a revascularization method is very helpful in this matter. Effective treatment options are usually limited. Neurointerventional maneuvers have recently emerged as a possible therapeutic modality in this field. We present the case of a 52-year-old woman who had open heart surgery in Queen Alia Heart Institute, Jordan, to replace a severely stenotic rheumatic mitral valve and repair a leaking tricuspid valve. Her surgery went smoothly with no major event. However, she developed a massive ischemic stroke during her recovery period despite being on adequate anticoagulation therapy. Urgent radiological work-up confirmed the diagnosis of ischemic stroke in the territory of the right middle cerebral artery. We chose a neuro-interventional method for her treatment, and mechanical thrombectomy was performed with a successful outcome and no apparent complications.
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