Clinical Features and Endovascular Management of Iliac Arteriovenous Fistulas: A 10-Year Single Center Experience

Abstract

ObjectiveIliac arteriovenous fistulas (IAVFs) are rare abnormalities with limited reported cases. This study aimed to summarize the clinical features and experiences on the diagnosis and endovascular treatment of IAVFs.MethodsA single-center retrospective study of IAVFs from 2010 to 2019 was performed. Data including demographics, clinical characteristics, radiological images, surgical details, and follow-up were collected.ResultsA total of 16 patients diagnosed with IAVFs were identified. The female to male ratio was 3:1. The mean age was 47.7 ± 10.4 years (range: 35–73 years). Leg swelling and cardiac insufficiency, especially heart failure, were the most common primary symptoms in this series, which were revealed in 68.8 and 37.5% of patients, respectively. Iatrogenic, traumatic, and congenital IAVFs were diagnosed in 62.5, 12.5, and 25.0% of patients, respectively, among which hysterectomy was thought to be the main cause for female iatrogenic IAVFs (31.3%). Anatomic analysis found that internal iliac vessels were the predilected sites of IAVFs. All the patients were treated by endovascular procedures composed of transarterial embolization (50.0%), transarterial and stage II transvenous embolization (31.3%), stage I transarterial and transvenous embolization (12.5%), and transarterial embolization plus stent implantation (6.3%). The clinical success rate was 93.8%. Minor complications including fever (18.8%) and exudation at the puncture point (6.25%) were noted and well-treated. During a follow-up period of 51.3 ± 41.9 months after operations, only one patient experienced re-emergence of heart failure because of recurrence of leiomyosarcoma; other patients recovered uneventfully with symptoms relief and no severe embolization-related complications was encountered.ConclusionIAVFs are rare disorders and correct diagnosis requires careful history taking and physical examination, combined with proper imaging investigation. The primary goal for treatment of IAVFs was to relieve associated symptoms. Based on the results of this study, endovascular approach is safe and effective for treatment of IAVFs.

Spontaneous Iliac Arteriovenous Fistula Leading to High-Output Heart Failure and Cardiac Arrest

“…Treatment options vary from temporary conservative management through compression therapy or more definitively through open or endovascular repair with vascular surgery [ 6 ]. The principal objectives of treatment are arterial repair and removal of venous communication to prevent further arterial dilation, rupture, and progression of sequelae such as high-output heart failure [ 7 ].…”

Closure of Post-thrombotic Iliac Arteriovenous Fistulas by Iliac Vein Recanalization

“…The detection of iliac AVF requires careful consideration of different potential etiologies 1 : apart from iatrogenic AVF following catheterization procedures or pelvic surgery, congenital iliac AVF warrants mention. 1 , 2 Large congenital AVF potentially provoke massive cardiac dilation and ectasia of the inferior vena cava, which might be accompanied by high-output heart failure. 2 In such cases, monitoring of cardiac imaging and function is essential.…”

High Output Heart Failure Due to Iatrogenic Iliac Arteriovenous Fistula

“…Iliac AVF has been described as a rare complication following LDS or uterine surgeries, including cesarean section and hysterectomy. 1 The uterus is adjacent to the iliac vessels, so iliac vascular injury during hysterectomy is possible. The mechanism of injury during LDS is probably direct force from the sharp instrument which passed through the anterior longitudinal ligament at the L4-5 or L5-S1 level, causing the fistula between the common iliac artery and vein.…”