Postoperative systemic artery to pulmonary vessel fistula: analysis of three cases

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][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. 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.…”

“…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. 7) Therapeutic options include conservative management with observation, surgical ligation, and embolization, but the best treatment remains controversial.…”

“…[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.…”