Endovascular correction of a traumatic internal iliac arteriovenous fistula with a covered stent

Abstract

Arteriovenous fistulae (AVFs) are anomalous communications between an artery and a vein, bypassing the capillary network. They can be subdivided on the basis of etiology into congenital and acquired fistulae. The latter may be caused by closed or penetrating traumas, or may be iatrogenic injuries. We report on a case of a young adult female gunshot wound victim treated with emergency laparotomy who developed asymmetrical edema of the lower limbs during the late postoperative period. Imaging exams showed the presence of a left internal iliac AVF, treated using endovascular surgery with placement of a covered stent, resulting in total occlusion of arteriovenous communication.Keywords: traumatic arteriovenous fistula; endovascular surgery; internal iliac artery. ResumoAs fístulas arteriovenosas (FAVs) são comunicações anômalas entre uma artéria e uma veia, sem envolvimento capilar. Segundo sua etiologia, podem ser divididas em congênitas e adquiridas, resultantes de traumas fechados ou penetrantes, e de lesões iatrogênicas. Relatamos o caso de mulher jovem, vítima de ferimento por arma de fogo, submetida à laparotomia de urgência, que evoluiu no pós-operatório tardio com edema assimétrico de membros inferiores. Os exames de imagem demonstraram a presença de fístula arteriovenosa ilíaca interna esquerda, tratada através de cirurgia endovascular com stent revestido, determinando a total oclusão da comunicação arterial e venosa.Palavras-chave: fístula arteriovenosa traumática; cirurgia endovascular; ilíaca interna.

Correção cirúrgica de pseudoaneurismas e fístula arteriovenosa complexa entre vasos poplíteos

“…Venous ligature should be avoided because of the possibility of chronic venous hypertension of the limb and its medium and long-term clinical repercussions. 1 In the case reported here, popliteal vein ligature was performed because of the risk of thrombosis of the large venous aneurysm and of emboli after the AVF was closed. Additionally, reconstruction with a venous graft, which had been planned initially, was not performed because of hemodynamic instability.…”

“…An arteriovenous fistula (AVF) is an abnormal and permanent communication between an artery and a vein, 1,2 which is generally associated with penetrating traumas and iatrogenic injuries. 1,3 The duration of clinical presentation and the time that elapses between trauma and diagnosis vary and may even run to decades. 4 Penetrating traumas to the artery wall can cause formation of pseudoaneurysms and, if there is also venous damage, to development of AVF.…”

Correção cirúrgica de fístula carotídeo-jugular traumática

“…11 Diagnosis of traumatic AVF and PSA requires careful history taking and clinical examination, although noninvasive and invasive diagnostic methods may also be needed. 4,12 Signs and symptoms of AVF include pulsation in the neck area, edema, systolic murmur, thrill, and dilation of superficial veins. [12][13][14] A machinery (or locomotive) murmur is pathognomonic for AVF 15 and the Nicoladoni-Branham sign, comprising bradycardia and increased mean blood pressure in response to manual compression of the fistula, can be observed in some cases.…”

“…4,12 Signs and symptoms of AVF include pulsation in the neck area, edema, systolic murmur, thrill, and dilation of superficial veins. [12][13][14] A machinery (or locomotive) murmur is pathognomonic for AVF 15 and the Nicoladoni-Branham sign, comprising bradycardia and increased mean blood pressure in response to manual compression of the fistula, can be observed in some cases. [16][17][18] Immediate surgical intervention is indicated in cases with evident vascular injury and hemodynamic instability.…”

“…8 Elective treatments should be preceded by careful therapeutic planning, including anatomic assessment of the structures involved. 4,12 AngioCT, magnetic resonance imaging (MRI), and Doppler ultrasonography are often employed and, in some cases, angiography can play an important role in planning, whether for conventional, endovascular, or hybrid surgery. 4,16,18 In the case described above, arteriography only showed intracranial opacification when the catheter was advanced distally of the AVF.…”