An Adult Case of Internal Mammary Arterio-Venous Fistula

Abstract

A left internal mammary artery to vein fistula was found incidentally in a 32-year-old woman with a continuous murmur. There was no significant history of trauma and no cardiac symptoms. A percutaneous embolization with vascular plug and coil was performed.

Coil embolization of a symptomatic left internal mammary arteriovenous fistula

“…When undertaking the transcatheter approach, it is important to completely embolize proximal and distal to the AVF in order to prevent any recurrence or treatment failure due to backflow from collaterals . In our patient, initial coil embolization by direct percutaneous access resulted in minimal flow into the AVF; however, we noticed residual flow into the AVF via a small LIMA feeder branch.…”

“…There are few case reports of LIMA AVFs in the literature, with congenital malformations, traumatic causes, and iatrogenic injuries being the most commonly reported etiologies . It is surprising that this malformation developed in our patient, given that we did not harvest the LIMA and the sternal wires did not appear to be in direct contact with the AVF.…”