Endovascular Repair of a Left Axillary–Left Pulmonary Artery Fistula: Report of a Case

Abstract

An abnormal communication between an artery of the systemic circulation and a pulmonary artery represents a rare clinical condition. A 76-year-old man presented with nocturnal dyspnea and retrosternal pain caused by a non-ST-elevation acute coronary syndrome. He had a history of a coronary artery bypass grafting operation 17 years previously, which required a repeat procedure 7 years later with a construction of an anastomosis of the left internal thoracic artery to the left anterior descending artery. Coronary angiography revealed an abnormal fistulous communication between the left axillary and the left pulmonary artery. Pressure measurements revealed pulmonary hypertension. An endovascular repair of the fistula was performed during repeat coronary angiography with an implantation of two self-expandable covered polytetrafluoroethylene stent grafts measuring 9 and 10 mm in diameter respectively, and thus resulting in a complete obstruction of the abnormal communication. During a follow-up period of 2 months the patient showed a significant improvement in his clinical condition.

Use of Coils and a Pulmonary Vasodilator to Reduce Pulmonary Hypertension in a Patient with Interstitial Pneumonia and Scleroderma

“…Such occlusion was performed using coils because this procedue is easier to perform and has less risk (general anesthesia is not required and there is less loss of the lung parenchyma) (2, 3, 8, 9). There are still some risks of embolization associated with perforation of a vessel, hemorrhage, or formation of a new shunt, however, in several reported SA-PAF cases that had sufficient follow-up, those complications did not occur (2,8,9). The success rate of this procedure, especially compared with other treatments, is still quite high (2,8,9).…”

Axillary Artery to Pulmonary Artery Fistula following Nuss Procedure for Pectus Excavatum

“…The most common feeding arteries of an SAPVF are the internal mammary and intercostal arteries, but they may arise from abnormal aortic branches and subclavian, axillary, diaphragmatic, mediastinal or coronary arteries. [3][4][5][6][7] Outflow of an SAPVF can be the pulmonary artery, or pulmonary vein, or both. 3) There has been only one SAPVF report that had the axillary artery as a feeding artery developing following coronary artery bypass graft; thus, our report will be the second one.…”

“…3) There has been only one SAPVF report that had the axillary artery as a feeding artery developing following coronary artery bypass graft; thus, our report will be the second one. 6) SAPVFs are congenital more than 50% of the time, but some SAPVFs may develop as a consequence of tumors, inflammatory processes of the pleura or lung, or after blunt, open, or iatrogenic chest injuries. [1][2][3][4] SAPVF of the present case developed due to long-standing inflammatory and adhesive processes at the bar removal site.…”

“…The etiology of SAPVF is generally thought to be due to adhesions that bridge the pleura from the chest wall to the lung, which then may develop new blood vessels that are large enough to cause significant systemic-pulmonary fistulas. 6) Despite the presence of a left to right shunt, no symptoms are usually present, and the fistulae are discovered during a routine physical examination. 3) The natural clinical history of SAPVF is not well known, but significant complications can occur, such as hemoptysis, cardiac failure, pulmonary arterial hypertension, endocarditis, and rupture.…”

“…[1][2][3][4][5][6][7] Although most published cases reported internal mammary arteries and intercostal arteries as feeding arteries, only one case reported a SAPVF between the axillary artery and pulmonary vessels. [3][4][5][6][7] We recently encountered a patient with acquired axillary artery to pulmonary artery fistula detected by dualsource 64-slice CT (DSCT) angiography who had a Nuss surgical procedure for pectus excavatum. He suffered from wound infection following bar removal.…”