Treatment of acquired arteriovenous fistula with severe hemodynamic effects: therapeutic challenge

Abstract

A 34-year-old female patient with severe heart failure and pulmonary hypertension was diagnosed late with a highoutput acquired arteriovenous fistula between the right common iliac vein and artery. The most probable cause was an iatrogenic vascular injury inflicted during a prior laparoscopic cholecystectomy. Treatment was conducted by placement of an endoprosthesis in the common iliac artery, achieving total exclusion of the fistula and complete remission of symptoms. Considering the options available for treating this type of lesion, endovascular techniques are becoming ever more effective and are now the option of first-choice for management of this pathology.Keywords: arteriovenous fistula; endoprothesis; heart failure. ResumoPaciente de 34 anos com quadro de insuficiência cardíaca e hipertensão pulmonar severas, com diagnóstico tardio de fístula arteriovenosa adquirida de alto débito entre a veia e a artéria ilíaca comum direita. A provável causa foi relacionada à lesão vascular iatrogênica em colecistectomia laparoscópica realizada previamente. O tratamento foi realizado com endoprótese em artéria ilíaca comum, resultando em exclusão total da fístula e remissão completa dos sintomas. Considerando-se as opções de tratamento para esse tipo de lesão, a técnica endovascular tem se mostrado cada vez mais eficaz e tem se tornado a primeira opção no manejo dessa patologia.Palavras-chave: fístula arteriovenosa; endoprótese; insuficiência cardíaca.

Fístula arteriovenosa pós-cateterismo radial com repercussões cardiopulmonares

“…In these circumstances, the cardiac decompensation provoked by the AVF tends to manifest early, weeks or a few months after the event. 7,8 In addition to murmur and thrill, if palpable, AVFs with hemodynamic impact tend to manifest with progressive dilation of the veins receiving the arterial blood supply, edema of the extremity involved, and cardiac overload to the point of causing heart failure. However, this characteristic presentation may not occur in up to half of cases, notably in circumstances in which the AVF arises in vessels of medium and small caliber that are farther from the heart.…”

Endovascular Repair of Superior Mesenteric Arteriovenous Fistula Causing Early Mesenteric Steal Syndrome Following Abdominal Gunshot Injury

“…In most cases, radiological intervention is preferred as it is associated with reduced mortality, lower cost, allows repeated access for further intervention, and can be used for fistulae deemed too large for surgical intervention. 4 , 5 Early attempts at endoscopic intervention for SMAVF used coil embolisation of the aberrant tract. However, use of covered stents is recommended as embolisation in this context carries a significant risk of coil migration, distal enteric arterial occlusion, or porto-mesenteric venous thrombosis.…”