Venous Covered Stent: Successful Occlusion of a Symptomatic Internal Iliac Arteriovenous Fistula

Abstract

We report the placement of a covered stent within the internal iliac vein (IIV) to occlude a symptomatic iatrogenic internal iliac arteriovenous fistula following an abdominal aortic graft. Angiography revealed a direct communication between an internal iliac graft to artery anastomosis and the right IIV with rapid shunting into the inferior vena cava and a small associated pseudoaneurysm. Femoral, brachial or axillary arterial access was precluded. The fistula was successfully occluded by a stent-graft placed in the IIV. Arteriovenous fistula can be treated in a number of ways including covered stent placement on the arterial side. To the best of our knowledge this is the first time placement in a vein has been described. Where access is difficult or the procedure carries a high risk of complication, a venous covered stent may offer an alternative.

Endovascular treatment of iatrogenic arteriovenous fistula of the iliac vessel

“…3,15,16,18 As immediate surgical treatment due to life-threatening condition, is a 1 st line treatment, the benefits of minimal invasive approach in the form of endovascular procedure may result in lower morbidity and mortality. 2,3,5,[7][8][9][10]21,23,25,26 We, therefore, suggest establishing a complications' register. 27…”

“…15,18,21 The diagnostic methods allow us to diagnose the patient with iatrogenic vessel injury include Doppler ultrasound, CT-angiography, MRI-angiography or angiography. 11,[21][22][23] The vessel injuries, including arteriovenous fistulas, are often detected intraoperatively, which is associated with high mortality rates. 24 The therapy of vascular complications of neurosurgical and orthopedic procedures includes both open surgery and endovascular procedures.…”

Vertebral artery stent graft for a chronic symptomatic vertebrojugular arteriovenous fistula

“…10 This is effective where there is a short, direct AVF. In our patient, occlusion of the connection to the IJV with a jugular vein stent graft would have probably failed because the paravertebral plexus could still preserve patency of the AVF.…”

Taking the stent in vein: Interventions in the other half of the vascular tree

“…Stenting has arrived as therapy for venous stenosis. Multiple reports are now appearing for stent placement in veins [1, 20–32]. While arterial stenosis is overwhelmingly due to atherosclerosis, venous stenosis arises from a multiplicity of causes.…”