Remission of heart failure through endoluminal repair of femoral arteriovenous fistula with the use of a covered stent

We report the case of a 21-year-old male with high-output heart failure due to a femoral arteriovenous fistula caused by a firearm wound. A new balloon expandable stent covered with polytetrafluorethylene was implanted in the artery to occlude the arteriovenous fistula. The fistula was immediately occluded and the artery remained patent. On the following day, the patient felt much better, with no symptoms of heart failure. Additional follow-up is required to assure the usefulness of this less invasive procedure in the treatment of arteriovenous fistulas.     

Transcatheter redirection of hepatic venous blood to treat unilateral pulmonary arteriovenous malformations in a Fontan circulation by short‐term total exclusion of the unaffected lung

Clinically significant unilateral pulmonary arteriovenous malformations (PAVM) can develop in patients with a Fontan circulation when there is unbalanced distribution of hepatic venous (HV) blood flow to the lungs. There are reported surgical and transcatheter techniques to treat PAVMs by rerouting HV return, with promising short‐term results. We report a case of a novel, technically simple transcatheter approach to redirect HV blood flow in an adult Fontan patient with polysplenia syndrome and severe unilateral PAVMs. Our patient had a two‐stage procedure, the first to redirect all HV blood flow to the affected lung with a single covered stent, and a second to confirm resolution of PAVMs and to reintroduce HV effluent to the unaffected lung. At 10‐month follow‐up, her oxygen saturations had increased from 75% to 93% with a marked improvement in her functional status.     

Transcatheter brachial fistula creation for treatment of pulmonary arteriovenous malformations

Pulmonary arteriovenous malformations (PAVMs) are thought to form as a result of exclusion of hepatic venous blood from part of the pulmonary circulation. Surgical arteriovenous (AV) fistula creation has demonstrated therapeutic potential to reverse PAVM formation. We sought to demonstrate the feasibility and safety of transcatheter AV fistula creation for this indication. Fluoroscopically guided puncture from the basilic vein into the brachial artery using a Brockenbrough needle and sharpened 0.014” wire created a tract between these vessels. After balloon dilation of the tract, a covered stent was deployed, resulting in a functioning brachial AV fistula. The procedure was technically successful, with no clinical complications at 4 months follow‐up. Repeat diagnostic catheterization revealed marked improvement in systemic saturation and near‐resolution of PAVMs in the pilot patient. This report suggests that transcatheter brachial arteriovenous fistula formation is technically feasible, and may be effective in managing PAVMs in select single‐ventricle patients. © 2013 Wiley Periodicals, Inc.     

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.     

Stent grafting for coronary arteriovenous fistula with adjacent atherosclerotic plaque in a patient with myocardial infarction

Coronary arteriovenous fistula is a relatively common congenital anomaly of coronary artery. Currently, percutaneous transcatheter embolization and surgical ligation are two commonly utilized management techniques. Stent grafts have recently been applied for various coronary lesions such as coronary perforation and coronary aneurysm. We report a case of coronary arteriovenous fistula with adjacent atherosclerotic plaque successfully treated with coronary stent grafting in a patient who presented with acute myocardial infarction.     

Endovascular stent implantation in a coronary artery to pulmonary artery fistula in a patient with pulmonary atresia with ventricular septal defect and severe cyanosis.

A 31-year-old male with pulmonary atresia, ventricular septal defect presented with exercise intolerance and severe cyanosis. A restrictive coronary-pulmonary artery fistula was identified as the main source of pulmonary blood flow. We report transcatheter stent implantation in the fistula to augment pulmonary flow as a palliative management option in the adult patient with complex congenital heart disease.     

Amplatzer vascular plug closure of a subclavian arteriovenous fistula associated with implantable cardioverter‐defibrillator implantation

Subclavian arteriovenous fistula (AVF) is a rare complication of implantable cardioverter‐defibrillator (ICD) implantation. This report illustrates the case of a subclavian AVF after ICD implantation in a patient with nonischemic cardiomyopathy and the successful closure of this AVF using an Amplatzer vascular occlusion plug. Given the increasing number of ICD implantations, physicians should be made aware of this uncommon complication. In addition, as more percutaneous endovascular techniques are developed to treat peripheral vascular and structural heart disease, iatrogenic AVFs may occur more frequently. The Amplatzer vascular plug should be considered as a potential treatment strategy for AVFs alongside other endovascular and surgical techniques. © 2011 Wiley‐Liss, Inc.     

Impact of a large hemodialysis arteriovenous fistula: on myocardial protection during cardiopulmonary bypass

Arteriovenous fistulae have a substantial impact on systemic hemodynamics, but their effect on cardiopulmonary bypass is not well understood. The left-to-right shunting of blood through an arteriovenous fistula can create flow problems during cardiopulmonary bypass. We present the case of a 59-year-old man with end-stage renal disease who underwent coronary artery bypass grafting. During surgery, a large brachiocephalic arteriovenous fistula provided excessive venous return to the heart, compromising the myocardial protection offered by cardiopulmonary bypass. We modified the venous cannulation from a 2-stage single cannula to a bicaval cannula and were then able to achieve cardioplegic arrest and myocardial protection with no further problems.     

Multiple pulmonary arteriovenous fistulas in childhood

Three cases of multiple pulmonary arteriovenous fistulas are described in children who presented at five months, two and nine years of age. Mass spectrometry was used to measure pulmonary blood flow and, in two cases, the intrapulmonary right-to-left shunt. The shunt fractions were 51% and 35%, with no significant change on breathing 100% oxygen. In one case, effective pulmonary blood flow was measured during cardiac catheterisation by the argon-freon rebreathing method and agreed closely with that found from the Fick, principle with measured oxygen consumption. Treatment consisted of surgical ligation of a lower lobe pulmonary artery in the youngest child, balloon embolisation in the second, and initial surgical oversewing of a single large fistula followed twenty months later by steel coil embolisation in the third. The last and oldest child is well and no longer cyanosed. The first two children died seven months after treatment with evidence of progression of their pulmonary arteriovenous fistulas. The first of these, who also had an atrial septal defect and discordant thoraco-abdominal arrangement, died of heart failure. Autopsies on both children confirmed extensive involvement of both lungs by arteriovenous fistulas. In one case who had a diffuse, telangiectatic form of pulmonary arteriovenous fistulas, microscopic serial reconstructions of lung tissue revealed that anastomoses occurred between arteries accompanying terminal bronchioles and intra-acinar arteries and adjacent veins. Occlusion of the pulmonary arteries supplying the fistulas led to extensive fibrosis within them, and was associated with enlargement of the corresponding bronchial arterial circulation.     

Use of the Gore Viabahn VBX balloon‐expandable endoprosthesis in the congenital heart disease population

The Gore Viabahn VBX balloon‐expandable endoprosthesis (W. L. Gore & Associates, Flagstaff, AZ) is a flexible covered stent that is FDA‐approved for the treatment of iliac artery stenosis, including lesions at the aortic bifurcation. In this case series, we report the first use of the VBX covered stent in congenital heart disease, highlighting several of its unique advantages.     

Percutaneous stenting of bilateral central venous occlusions in a hemodialysis patient

Upper-extremity central venous obstruction is often first recognized when an arteriovenous fistula is made for hemodialysis at an ipsilateral site. We encountered a case of markedly expanded edema after making an arteriovenous fistula in the left forearm. Systemic venography showed that the bilateral brachiocephalic veins and right subclavian vein were occluded. Implantation of a self-expandable stent in the left brachiocephalic vein relieved the edema. However, recurrence of similar edema and occlusion of the left brachiocephalic vein were noted after 1.5 years. The left brachiocephalic vein was then recanalized by ballooning and additional stent implantation, and a stent was implanted between the superior vena cava and right subclavian vein. Simultaneous reconstruction of the bilateral central venous obstruction by percutaneous intervention rather than surgical repair was suitable for this patient because of previous thoracoplasty. We also believe that this method can provide an opportunity to select the suitable forearm for making an arteriovenous fistula, in which the ipsilateral central vein will exhibit little restenosis.     

Transcatheter polytetrafluoroethylene-covered stent implantation in a giant coronary artery aneurysm of a child with Kawasaki disease--a potential novel treatment.

We report a case of an eight-year-old boy with Kawasaki disease (KD) who had a giant aneurysm with stenotic lesions located in the right coronary artery, and was treated by transcatheter implantation of a polytetrafluoroethylene(PTFE)-covered stent. Follow-up coronary angiography showed good coronary blood flow. To the best of our knowledge, this is the first child with KD who underwent covered-stent implantation in a coronary aneurysm. Although close follow-up is mandatory, because the long-term outcome is unclear, implantation of a covered stent in a giant aneurysm appears to be a promising treatment option.     

Treatment of an iatrogenic femoral artery pseudoaneurysm with concomitant arteriovenous fistula with percutaneous implantation of an amplatzer vascular plug

Iatrogenic pseudoaneurysms can occur following percutaneous cardiac and peripheral procedures. There are multiple modalities available for the treatment of pseudoaneurysms including ultrasound guided compression repair, ultrasound guided thrombin injection, or endovascular repair with covered stent placement. If these methods are not indicated or unsuccessful, patients typically require open surgical repair. We report a case of a woman with a post‐procedural pseudoaneurysm with concomitant arteriovenous fistula who was treated percutaneously with the implantation of an Amplatzer vascular plug. This novel technique was safe and effective and allowed our patient to avoid the morbidity and mortality associated with surgical repair. © 2012 Wiley Periodicals, Inc.     

Prenatal Diagnosis of Left Pulmonary Artery-to-Pulmonary Vein Fistula and Its Successful Surgical Repair in a Neonate

Pulmonary arteriovenous fistula is a rare disease. To the best of our knowledge, prenatal diagnosis of a fistula between the left pulmonary artery and the left pulmonary vein has not been described in the medical literature. We report a case of the prenatal diagnosis of a left pulmonary artery-to-pulmonary vein fistula, followed by successful neonatal surgical repair.     

Treatment of a saphenous vein graft to right ventricle fistula with a PTFE-covered stent: a case report.

This report demonstrates the use of a covered stent for the correction of a fistula from a saphenous vein graft to the right ventricle. The use of this stent resulted in complete obliteration of the fistulous tract and restoration of flow into the sequential limb of the graft.     

气道Y型覆膜内支架置入的临床应用（附2例报道）

目的初步探讨气道Y型覆膜内支架治疗气管隆突和双主支气管复合病变（狭窄或瘘）的可行性和疗效。方法根据气道复合狭窄和食道／胸腔胃－隆突瘘的特殊解剖结构，设计Y型气道覆膜内支架。在纤维支气管镜指导及X线监视下，对2例气道复合病变患者置人Y型气道覆膜内支架。结果内支架均一次性置入成功，2例患者置人内支架后均症状缓解。生活质量提高。结论Y型覆膜气道内支架置入能有效解除气道复合病变，技术可行，操作简单、安全、近期疗效可靠，值得进一步推广应用。     

High-output Heart Failure Caused by a Tumor-related Arteriovenous Fistula: A Case Report and Literature Review

High-output heart failure caused by a tumor-related arteriovenous fistula in adults is a rare clinical condition. We herein report a case of high-output heart failure caused by an arteriovenous fistula associated with renal cell carcinoma and a literature review of 29 published cases to date. Renal cell carcinoma seems to be the most common underlying tumor. For the diagnosis, right heart catheterization and enhanced computed tomography (CT) are considered useful. The removal of the underlying tumor and arteriovenous fistula is the best treatment for heart failure.     

Coil occlusion of a femoral arteriovenous fistula.

A femoral arteriovenous fistula was discovered in a 17-mo-old child with congenital heart disease and prior femoral cardiac catheterization. The fistulous connection was clearly visible by angiography with vein compression, and the fistula was closed percutaneously using a Gianturco coil. Cathet. Cardiovasc. Intervent. 51:308-311, 2000.     

Long‐term outcome of transcatheter polytetrafluoroethylene‐covered stent implantation in a giant coronary aneurysm of a child with Kawasaki disease

We report the long‐term outcome of a child with Kawasaki disease (KD), who had a giant aneurysm with stenotic lesions in the right coronary artery, resulting in the transcatheter implantation of a polytetrafluoroethylene (PTFE)‐covered stent at the age of 8. Quantitative coronary angiography analysis later showed the increase of the diameter stenosis at both stent edges for the first 10 months after implantation; however, the stenosis did not develop thereafter. Coronary perfusion was still well maintained at follow‐up coronary angiography 5.5 years after implantation (diameter stenosis was 36.5% at proximal and 37.4% at distal edge, respectively). Although further follow‐up is necessary, the long‐term outcome of a PTFE‐covered stent implantation for a KD patient is satisfactory in this instance. Implantation of a covered stent in a giant aneurysm is considered a promising treatment option. © 2012 Wiley Periodicals, Inc.     

Use of a self-expandable covered stent for closure of a fistula at a cervical anastomosis after pharyngo-laryngo-esophagectomy: a case report

We report a case of a fistula caused by cervical anastomotic leakage after pharyngo-laryngo-esophagectomy that was successfully and safely treated with a self-expandable covered stent. A patient with esophageal carcinoma and inferior pharyngeal carcinoma underwent pharyngo-laryngo-esophagectomy. Postoperatively, a major anastomotic insufficiency formed with constant outflow of salivary juice. The fistula did not show a tendency to close, and therefore we decided to cover the primary orifice of the fistula from the inner side by placing a stent over the orifice. Stent placement was performed endoscopically on the 35th postoperative day. Fifteen days later, a gastrografin study showed closure of the fistula, and 21 days after placement the stent was removed successfully. In this case the patient had a permanent tracheostoma, and therefore the airway and digestive tract were separated. This condition may have contributed to the successful stent therapy that was performed without harmful effects on the airway.