Artery Fistula Research Articles

Comparison of Distal Arterial Hemodynamic Changes of the Upper Extremity Loop and Straight Arteriovenous Grafts

Hemodialysis access has been considered as a support for end-stage renal patients. We measured the hemodynamic changes of the distal part of the upper extremity immediately after providing the AVGs in each method mentioned above and then compared the results. This method is a novel one and hasn’t been used in any other studies before. We studied 32 patients referred to the vascular surgery department of Rasht Razi Hospital between 2019-2020 (using the Convenient Sampling method). This study is a case-control study. Out of 32 patients referred to the vascular surgery department of the hospital, 68.8% were male, and their mean age was 53.41±12.75 years, ranging from 28 to 78 years. Changes in distal arterial hemodynamics of the upper limb before and after clamping in dialysis venoarterial loop versus straight grafts are different in studied patients (P<0.05). The mean hemodynamic changes before and after clamping in loop venoarterial grafts (19.5000) are less than straight grafts. In dialysis patients who do not have any superficial vein suitable for venous, arterial fistula, surgical placement of artificial grafts in the upper limb is appropriate. Based on the results of this study, the loop method seems to have lesser ischemic Complications and can be applied to dialysis patients.

Clinical Characteristics of Coronary-to-Pulmonary Artery Fistula in Patients with Pulmonary Atresia and Ventricular Septal Defect.

The existence of a coronary-to-pulmonary artery fistula (CPF) in pulmonary atresia with ventricular septal defect (PAVSD) potentially affects treatment; however, its clinical features have not been comprehensively described due to the disease's rarity. We reviewed 69 cases from 42 studies to reveal the clinical overview of patients with CPF and PAVSD. Among the included patients, the male-to-female ratio was exactly 1:1, and only two patients (3%) exhibited the 22q11.2 microdeletion syndrome. Regarding anatomical features, CPFs originated from the left coronary artery in 65% of patients, and 62% had other major aortopulmonary collateral arteries. Thirty-nine percent of patients had a definitive CPF diagnosis at 0 years of age, whereas 10% were diagnosed in adulthood. Seventy percent underwent catheter angiography to obtain a definitive CPF diagnosis. Ninety-five percent of patients underwent cardiac surgery, and among them, 43% underwent palliative surgery, whereas 52% underwent one-stage repair. Four patients including three adult patients developed cardiac dysfunction due to myocardial ischemia, and three of them exhibited improved cardiac function after the intervention for CPF. Of all the patients, 88% survived and 12% died. The surgical strategy and prognosis were similar to those in PAVSD patients without CPF. This review provides detailed clinical phenotypes that are potentially useful in enhancing the management of patients with this rare disease.

Coronary-to-pulmonary artery fistula and Vieussens' arterial ring.

Coronary-to-pulmonary artery fistula and Vieussens' arterial ring.

Transcatheter Angiographic Embolization of Percutaneous Nephrolithotomy-Related Bleeding: A Single-Center Experience

Background To evaluate the clinical characteristics and angiographic features of transcatheter angiographic embolization (TAE) in patients with active bleeding after percutaneous nephrolithotomy (PCNL). Methods Between 2009 and 2018, 45 patients who underwent TAE for hemorrhage control after PCNL were reviewed retrospectively. Patient clinical characteristics and angiographic features of TAE were analyzed. Results Of the 3148 patients, 45 (1.4%) patients were treated with TAE after PCNL. The interval from the bleeding episode to TAE was 3 days (1,6). Arterial laceration, arteriovenous fistula, and negative angiographic finding were found in 28 (62.2%), 7 (15.6%), and 10 patients (22.2%). Thirty-five patients (92.1%) achieved primary clinical success. The median-corrected hemoglobin decrease from bleeding episode to TAE was 52 g/L (25.25, 71.00). The median-corrected hemoglobin decrease rate from bleeding episode to TAE was 13.11 g/L·d (5.60, 26.12). The hemoglobin decrease from bleeding episode to TAE was lesser in negative angiographic patients (28.50 (10.75,51.25) g/L VS 53.7 (35.0,73.13) g/L) than in positive angiographic patients (P < 0.05). Conclusions TAE is a safe and effective treatment for post-PCNL bleeding patients. Previous kidney surgery is associated with a higher risk of TAE. Patients with bleeding from multiple negative angiographic findings can be considered for prophylactic embolization.

A rare case report of trauma manifesting as multiple pseudoaneurysms of internal carotid artery and ipsilateral carotid cavernous fistula

Carotid cavernous fistula is commonly caused by head trauma. Carotid cavernous fistula may be associated with intracavernous aneurysm of internal carotid artery, but occurrence of aneurysm at other site is rare. Management becomes complicated when carotid cavernous fistula is associated with aneurysm. Carotid cavernous fistula and aneurysm are managed by endovascular coiling with or without stenting. The management is more complicated if aneurysm is in cervical internal carotid artery along with carotid cavernous fistula. The decision to first obliterate what varies according to patient and doctor. We are reporting one of the rarest case of post-traumatic cervical internal carotid artery pseudo-aneurysms with carotid cavernous fistula following blunt head-neck injury and evidence based management strategies in such cases.

Arterio-Venous Fistula of the Superficial Temporal Artery. An Interesting Differential for a Persistent Post-Traumatic Temporal Swelling

Arterio-Venous Fistula of the Superficial Temporal Artery. An Interesting Differential for a Persistent Post-Traumatic Temporal Swelling

Circumflex-to-Bronchial Artery Fistulas in Behçet's Disease

A coronary-to-bronchial artery fistula is a rare entity that emerged in the case of chronic pulmonary thromboembolism (cPTE). We present a case of a 50-year-old man with coronary-to-bronchial artery fistula in Behçet's disease that had been hospitalized in consequence of pulmonary thromboembolism attacks and treated with anticoagulation therapy repeatedly. After myocardial infarction was ruled out, coronary computerized tomography angiography was performed, and demonstrated right pulmonary artery occlusion, delay of the contrast passage in the right pulmonary veins, dilated right lung bronchial arteries, and fistulas between the right lung bronchial arteries and the left circumflex artery due to cPTE. Diagnosis of coronary-to bronchial artery fistula and early treatment are very important for the prevention of fatal complications. Radiologist and clinician should be alerted for this entity.

Exercise Headache Associated With an Arteriovenous Fistula of the External Carotid Artery.

Exercise Headache Associated With an Arteriovenous Fistula of the External Carotid Artery.

Coronary artery-to-pulmonary artery fistula in adults: evaluation with 320-row detector computed tomography coronary angiography

BackgroundTo analyze the imaging features of coronary artery-to-pulmonary artery fistula (CPAF) on coronary computed tomography angiography (CCTA).MethodsThis was a retrospective study of 3,975 patients who underwent 320 row detector CCTA examinations in our hospital from May 2015 to July 2020. A total of 22 patients who diagnosed with CPAF were reviewed for CCTA imaging characteristics, including the origin, number, blood volume, opening size, and course of fistula vessels, and the drainage site, size, and imaging features of the fistula. All cases were analyzed for the presence of coronary atherosclerotic plaque and that of deficient left ventricular myocardial perfusion.ResultsA total of 22 CPAF cases detected by CCTA were collected (men, 11; women, 11; median age, 59.6±10.1 years). There were 7, 10, and 5 cases detected with 1, 2, and 3 fistula vessels, respectively, among which 4 originated from the left coronary artery, 4 from the right coronary artery, and 14 had bilateral origins. There were 10 cases in which the fistula vessels presented as a worm-like tortuous dilation with (n=5) or without (n=5) aneurysm, while 12 cases showed malformed vascular networks with (n=8) or without (n=4) aneurysm, respectively. The calculated incidence of aneurysm formation was 59.09%, and fistula vessels with an aneurysm had larger blood volume than those without. All fistula showed a single drainage site, with an average diameter of 2.81±1.48 mm where the diameter of fistula with aneurysm was larger than that without. The fistula vessels drained into the left anterolateral and anterior walls of main pulmonary artery and the proximal left inferior PA, respectively. Typical jet sign, smoke sign, and isodensity sign were presented in 22, 14 and 1 case, respectively. For the coexistent abnormalities analyzed in 22 cases, 17 participants with CPAF demonstrated hypoperfusion of the fistula vessels, and 11 demonstrated calcified plaque accompanied with luminal stenosis to different degrees.ConclusionsThe 320-row detector CCTA can comprehensively characterize the morphological features of CPAF, which is an optimal choice for physicians to make an accurate assessment before formulating patient management strategies.

Congenital coronary artery-to-pulmonary fistula with giant aneurysmal dilatation and thrombus formation: a case report and review of literature

BackgroundCoronary artery-to-pulmonary artery fistula is a rare disorder characterized by abnormal vascular communication between the coronary artery and pulmonary artery. While most patients remain asymptomatic, some might exhibit symptoms of myocardial ischemia, congestive heart failure, or even sudden cardiac death if coronary aneurysm, thrombosis, infective carditis, or other congenital cardiac defects coexist.Case presentationWe present a 66-year-old male complaining of angina pectoris with a history of hypertension and active smoking. He was diagnosed with a coronary aneurysm based on coronary computed tomography angiography. We subsequently identified a coronary artery-to-pulmonary artery fistula with giant aneurysmal dilation on coronary angiography. Ultimately we conducted surgery ligation and aneurysmorrhaphy. During surgery, we discovered newly formed thrombus within the aneurysmal cavity. Histological analysis of the aneurysmal wall supported the diagnosis of the congenital disorder. Our patient was successfully discharged and remained asymptomatic at two months of follow-up.ConclusionWe presented a rare and complex combination of congenital coronary artery-to pulmonary artery fistula, giant coronary aneurysmal dilatation, and thrombosis through multi-modality evaluations.

MO746CARDIAC REMODELING AND PULMONARY HYPERTENSION IN HEMODIALYSIS PATIENTS

Abstract Background and Aims An important predictor of cardiovascular mortality and morbidity in hemodialysis patients is left ventricular hypertrophy. Also, pulmonary hypertension is a risk factor for mortality and cardiovascular events in hemodialysis patients. The aim of this study was to investigate cardiac remodeling and the dynamics of pulmonary arterial pressure during a year-long hemodialysis treatment and to evaluate relationship between pulmonary arterial pressure and blood flow in arteriovenous fistula. Method Hemodialysis patients (n=88; 42 males, 46 females, mean age was 51.7±13.0 years) were studied. Echocardiography and Doppler echocardiography were performed in the beginning of hemodialysis treatment and after a year. Echocardiographic evaluation was carried out on the day after dialysis. Left ventricular mass index (LVMI) was calculated. Left ventricular ejection fraction (LVEF) was measured by the echocardiographic Simpson method. Arteriovenous fistula flow was determined by Doppler echocardiography. Pulmonary hypertension was diagnosed according to criteria of Guidelines for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology. Results Pulmonary hypertension was diagnosed in 47 (53.4%) patients. Left ventricular hypertrophy was revealed in 71 (80.7%) patients. Only 2 (2.3%) patients had LVEF&amp;lt;50%. At the beginning of hemodialysis correlation was detected between systolic pulmonary arterial pressure and LVMI (r=0.52; P&amp;lt;0.001). Systolic pulmonary arterial pressure negatively correlated with left ventricular ejection fraction (r=-0.20; P=0.04). After a year of hemodialysis treatment LVMI decreased from 140.49±42.95 to 123.25±39.27 g/m2 (р=0.006) mainly due to a decrease in left ventricular end-diastolic dimension (from 50.23±6.48 to 45.13±5.24 mm, p=0.04) and systolic pulmonary arterial pressure decreased from 44.83±14.53 to 39.14±10.29 mmHg (р=0.002). Correlation wasn’t found between systolic pulmonary arterial pressure and arteriovenous fistula flow (r=0.17; p=0.4). Conclusion Pulmonary hypertension was diagnosed in half of patients at the beginning of hemodialysis treatment. Pulmonary hypertension in hemodialysis patients was associated with left ventricular hypertrophy, systolic left ventricular dysfunction. After a year-long hemodialysis treatment, a regress in left ventricular hypertrophy and a partial decrease in pulmonary arterial pressure were observed. There wasn’t correlation between arteriovenous fistula flow and systolic pulmonary arterial pressure.

Giant right coronary artery aneurysm and fistula into the coronary sinus

Giant right coronary artery aneurysm and fistula into the coronary sinus

Oclusão de volumosa fístula da artéria coronária direita para a cavidade ventricular direita utilizando Amplatzer® Vascular Plug II. Relato de caso e descrição técnica do procedimento

Coronary arteriovenous fistulas are rare anomalies that connect one or more coronary arteries to a cardiac chamber or other vascular structure. These communications can be occluded using percutaneous treatment, and there are currently several approaches and techniques. We report the case of an adolescent aged 12 years and 10 months, with a large fistula of the right coronary artery draining into the right ventricular cavity, in which the Amplatzer® Vascular Plug II device was used. The technical steps used are described in detail, with excellent immediate results.

Experience in the treatment of patients with rare arteriovenous spinal fistulas

Objective – to study the prevalence, clinical manifestations, features of diagnostics and effectiveness of treatment of rare arteriovenous spinal fistulas.Materials and methods. From 2004 to 2019 in SO «Scientific-practical Center of endovascular neuroradiology NAMS of Ukraine» were examined and treated 43 patients with spinal dural arteriovenous fistulas (DAVF) – type I arteriovenous malformations according to the Anson and Spetzler classification (1992). Only 2 (4.6 %) patients had an afferent effusion from the internal iliac artery with fistula at L5-S1 level. Magnetic resonance imaging and spinal selective subtraction angiography were used to diagnose arteriovenous fistulas. Liquid cyanoacrylate embolizant and transfemoral access were used for endovascular intervention, and posterior median access and single-level hemilaminectomy for microsurgical intervention.Results. Total DAVF exclusion from blood flow was achieved in both patients. One patient underwent microsurgical separation of DAVF, the other one was operated by a combination of endovascular and microsurgical techniques. Neurological improvement in the postoperative period was noted in both patients.Conclusions. Arteriovenous fistulas are diverse in clinical manifestations and radiographs. Verification of venous hypertensive myelopathy with the presence of pronounced perimedullary vessels on data of magnetic resonance imaging is the most specific feature of DAVF. If standard spinal angiography does not allow DAVF afferents to be verified it should be supplemented by selective catheterization of the internal iliac arteries, from where the arterial fistula can originate. The study of angioarchitectonics of arteriovenous fistula, according to angiography, makes it possible to choose surgical treatment to ensure effective and radical separation of arteriovenous fistula.

Increase of wall shear stress caused by arteriovenous fistula reduces neointimal hyperplasia after stent implantation in healthy arteries.

Wall shear stress plays a critical role in neointimal hyperplasia after stent implantation. It has been found that there is an inverse relation between wall shear stress and neointimal hyperplasia. This study hypothesized that the increase of arterial wall shear stress caused by arteriovenous fistula could reduce neointimal hyperplasia after stents implantation. Thirty-six male rabbits were randomly divided into three groups: STENT, rabbits received stent implantation into right common carotid artery; STENT/arteriovenous fistula, rabbits received stent implantation into right common carotid artery and carotid-jugular arteriovenous fistula; Control, rabbits received no treatment. After 21 days, stented common carotid artery specimens were harvested for histological staining and protein expression analysis. In STENT group, wall shear stress maintained at a low level from 43.2 to 48.9% of baseline. In STENT/arteriovenous fistula group, wall shear stress gradually increased to 86% over baseline. There was a more significant neointimal hyperplasia in group STENT compared with the STENT/arteriovenous fistula group (neointima area: 0.87mm2 versus 0.19mm2; neointima-to-media area ratio: 1.13 versus 0.18). Western blot analysis demonstrated that the protein level of endothelial nitric oxide synthase in STENT group was significantly lower than that in STENT/arteriovenous fistula group, but the protein levels of proliferating cell nuclear antigen, vascular cell adhesion molecule 1, phospho-p38 mitogen-activated protein kinase (Pp38), and phospho-c-Jun N-terminal kinase in STENT group were significantly higher than that in the STENT group. High wall shear stress caused by arteriovenous fistula as associated with the induction in neointimal hyperplasia after stent implantation. The underlying mechanisms may be related to modulating the expression and activation of endothelial nitric oxide synthase, vascular cell adhesion molecule 1, p38, and c-Jun N-terminal kinase.

Stent-Assisted Angioplasty (SAA) at the Level of the Common Femoral Artery Bifurcation: Long-Term Outcomes

BackgroundThe objective of this retrospective single-center study was to report the initial and the long-term outcome after stent-assisted angioplasty of occlusive disease at the common femoral artery.Materials and MethodsBetween 1995 and 2015, 94 limbs in 79 consecutive patients (54 men; mean age 70 ± 8.6 years) underwent angioplasty with self-expanding stent implantation in 94 common femoral arteries. Critical limb ischemia was present in 15 limbs (16%); the other patients had claudication.ResultsTechnical success was 99%. Complications occurred in 5/94 interventions (5.3%): puncture site hematomas (2), arteriovenous fistula (1), cholesterol embolism (1), and dissection of the access site artery (1). The intervention was outpatient-based in 98%. Median follow-up was 53 months. Ankle–brachial index (ABI) rose from 0.71 ± 0.17 to 1.0 ± 0.2 (p < .001) immediately after the intervention and was 1.03 ± 0.2 after 1 year and 0.96 ± 0.21 at the last follow-up visit (p < .001 compared to pre-interventional ABI). During follow-up, restenosis was found in 23/94 limbs (25%); 15 limbs were treated by angioplasty, 3 by surgery, and 5 conservatively. One limb was amputated below the knee 6 months after stent-assisted angioplasty (SAA). Death rate during follow-up was 35/79 patients (44%).ConclusionsSAA of the CFA resulted in high immediate success and a low complication rate. Restenosis rate was moderate, and target lesions could easily be retreated by angioplasty. The main hazard was not restenosis, but death during follow-up.

A Case of a Systemic-to-Pulmonary Artery Fistula and Its Endovascular Treatment

A Case of a Systemic-to-Pulmonary Artery Fistula and Its Endovascular Treatment

Conservative management of trachea-to-innominate artery transfixion with a guidewire during percutaneous tracheostomy: a case report

BackgroundTracheostomy is a standard procedure in critically ill patients requiring mechanical ventilation or airway protection for extended periods. The main cause of death is haemorrhage, most commonly owing to a trachea-to-innominate artery fistula, usually requiring surgical treatment.Case presentationHere we report the case of an 83-yr-old woman with a subarachnoid haemorrhage, who incurred a trachea-to-innominate artery transfixion following percutaneous tracheostomy, successfully and conservatively managed by interventional radiology.ConclusionsThe use of peri-procedural ultrasound examination of the neck can reduce the risk of complications related to vessel anatomical variants. When the tracheostomy is complicated by bleeding, the procedure should be stopped in order to diagnose the vascular iatrogenic injury and to evaluate the best therapeutic approach by a multidisciplinary team.

15A rare case of coronary-to-phrenic artery fistula

15A rare case of coronary-to-phrenic artery fistula

Effect of Pre-operative Forearm Exercises on Arterial Venous Fistula Maturation and Blood Flow

Effect of Pre-operative Forearm Exercises on Arterial Venous Fistula Maturation and Blood Flow