The brachiocephalic fistula: a successful secondary vascular access procedure

In the period from January 1988 to July 1989, 185 arteriovenous conduits for hemodialysis were created in 150 patients with end stage renal disease including 20 procedures (13 patients) performed as emergency external shunts. Of the remaining patients 125/137 (139 procedures) could be followed. The procedures included 85 end-to-side radiocephalic wrist fistulas, 42 end-to-side brachiocephalic elbow fistulas and 12 brachioaxillary grafts. Complications associated with brachiocephalic fistulas were not significantly higher than with radiocephalic fistulas, except for the development of arterial steal and pseudoaneurysm formation. The 12-month patency rates were 72% and 75% in radiocephalic and brachiocephalic fistulas respectively. The end-to-side brachiocephalic fistula is a successful secondary vascular access procedure and is recommended when a primary radiocephalic fistula fails.     

Congenital arteriovenous fistula between an intercostal artery and the left brachiocephalic vein

Congenital arteriovenous fistulas between the thoracic arteries and the systemic veins are rare, and in clinical terms may mimic patency of the arterial duct. We present a neonate with a large arteriovenous fistula between the left sixth intercostal artery and the left brachiocephalic vein, to the best of our knowledge a unique site of drainage. To our knowledge, ours is also the earliest presentation and treatment of a thoracic arteriovenous fistula.     

Iatrogenic fistula from the aorta to the left marginal coronary vein

We report the first documented case of iatrogenic aortocoronary fistula to the left marginal coronary vein following coronary bypass surgery. Unique clinical data, findings from catheterization, and angiographic features are presented and compared with those in the seven previously reported cases of iatrogenic aortocoronary venous fistulae after coronary bypass operations.     

Right pulmonary artery-to-left atrial fistula: a differential diagnosis of cyanosis without structural heart disease

We present the case of a 19-year-old male who presented with late-onset cyanosis and a normal cardiovascular system examination. Contrast echocardiography revealed a right-to-left shunt. A right pulmonary artery-to-left atrial fistula was seen on the angiogram, which was surgically corrected. Early intervention is indicated to prevent complications in patients with this condition.     

Stent fracture in the left brachiocephalic vein

A 68-year-old male hemodialysis patient presented with severe congestion in his left arm. Left arm venography showed a completely occluded left brachiocephalic vein. We chose a self-expandable stent for treating this vein. However, restenosis occurred once at 8 months and again after six additional months. The cause of the restenosis was considered to be a stent fracture. On the first restenosis, we performed redilation with a balloon; on the second restenosis, we chose stent-in-stent with a balloon-expandable stent. At least 9 months after the stent-in-stent procedure, there has been no edema in his left arm. Therefore, stent-in-stent is one of the useful strategies for stent fracture in central venous obstruction.     

Iatrogenic left pulmonary artery to left atrium fistula

Trans‐catheter balloon angioplasty is a well‐established treatment modality for pulmonary artery (PA) stenosis in children with congenital heart disease. We report a case of an unusual complication where a fistula developed between the left PA and the left atrium during balloon angioplasty in a patient with history of tetralogy of Fallot. This was successfully treated with placement of a covered stent. © 2014 Wiley Periodicals, Inc.     

A case report of anomalous left brachiocephalic vein

An anomalous case of a left brachiocephalic vein passing behind the ascending aorta was observed in a 49-year Japanese man. This is known as anomalous left brachiocephalic vein. The anomalous left brachiocephalic vein descended along the left mediastinum in a position identical to that of a persistent left superior vena cava, so the diagnosis of this venous abnormally require carefully considered. Many cases of anomalous left brachiocephalic vein have been reported based on autopsy findings, but this venous anomaly was recently demonstrated by ultrasonography, CT, and MRI.     

Traumatic fistula between the brachiocephalic trunk and the brachiocephalic vein due to gunshot wound

We describe the case of a 49-year old male patient who suffered a gunshot wound in the chest which transfixed the medial mediastinum. He was hemodynamically stable, but had tachycardia and tachypnea. He was submitted to integrated work-up with chest radiogram, transthoracic echocardiography, computerized chest tomography, and arteriography of the aortic arch. A traumatic fistula was evidenced between the brachiocephalic trunk and the brachiocephalic vein. Surgical repair was performed using extracorporeal circulation and deep hypothermia with total circulatory arrest. The patient progressed well and was discharged on the fifth day postoperatively.     

Iatrogenic internal mammary artery to coronary vein fistula

Iatrogenic aortocoronary vein fistula following coronary artery bypass surgery is a rare complication. We describe the first reported case of inadvertent anastomosis of the left internal mammary artery to cardiac vein. The clinical characteristics and consequences as well as the angiographic characteristics of this fistula are described. Precautions that may be taken to prevent this complication are also addressed.     

Iatrogenic fistula between the left anterior descending coronary artery and anterior interventricular vein following stenting

We describe the case of a 61-year-old male who had a critical stenosis of the left anterior descending artery (LAD). Intravascular ultrasound demonstrated that the LAD was attached to a large anterior interventricular vein (AIV). After stenting, a fistula was noted between the LAD and AIV, which was successfully sealed by deploying a covered stent. To our knowledge, this is the first case of iatrogenic arteriovenous fistula between the LAD and AIV that occurred following stenting of the LAD.     

Fatal left internal mammary artery graft to subclavian vein fistula complicating dual-chamber pacemaker implantation.

We describe the case of a 75-year-old woman with an iatrogenic fistula between a left internal mammary artery graft to the left anterior descending coronary artery and the left subclavian vein that developed after implantation of a dual-chamber pacemaker.     

Iatrogenic left atrioventricular fistula after aortic valve re-replacement

Left ventriculoatrial fistula is a very rare cardiac disorder. The case is reported of a male patient who was admitted to the authors' clinic with dyspnea and fatigue. The patient had an atrioventricular fistula between the left atrium and left ventricle, and had undergone aortic valve re-replacement for prosthesis malfunction about one year previously. The fistula was considered to be the result of iatrogenic injury related to valve re-replacement surgery.     

Absence of the left brachiocephalic vein with venous return through the left superior intercostal vein: CT findings

Asymptomatic congenital thoracic venous anomalies are becoming clinically more relevant with the increasing utilization of minimally invasive surgical vascular procedures, such as left-sided implantable cardioverter defibrillator implantation. The purpose of this report is to describe the computed tomography findings of the congenital absence of the left brachiocephalic vein in a patient with no evidence of congenital cardiovascular disease and no prior history of central venous instrumentation. In this patient, the left internal jugular and the left subclavian veins drain via the left superior intercostal vein, the accessory hemiazygous, the hemiazygous, and the azygous vein into the right brachiocephalic vein to form the superior vena cava. The clinical significance and possible embryogenesis of this anomaly are discussed.     

Right hydrothorax after left subclavian and internal jugular vein catheterization: a delayed complication

Central vein catheterization is a common procedure performed in major hospitals. Numerous complications have been described with the use of this technique. We present three patients in whom the positioning of a catheter at the junction of the right and left brachiocephalic veins caused hydrothorax. Placing the catheter at the junction of the superior vena cava and the right atrium is recommended.     

Aberrant patent ductus arteriosus associated with double brachiocephalic trunk and interrupted left subclavian artery

Although patent ductus arteriosus (PDA) is the most common type of extracardiac shunt, aberrant PDA associated with other cardiac malformations as double brachiocephalic trunk and interrupted left subclavian artery is extremely rare. To the best of our knowledge, the literature contains no other report of a patient who has PDA originated from left subclavian artery associated with ventricular septal defect (VSD), double brachiocephalic trunk and interrupted left subclavian artery.