Giant Arteriovenous Fistula Research Articles

Giant arteriovenous fistula pseudoaneurysm resection: case report

Introduction: It has been estimated that pseudoaneurysms appear in 4% of patients with autologous arteriovenous fistulas, mainly in the venous segment of those accesses with more than five years of evolution caused by rupture of the vessel wall and the consequent extravasation of blood to adjacent tissues. Objective: Describe a case with a resection giant arteriovenous fistula pseudoaneurysm and a review of literature. Case report: A 51-year-old male patient with a history of chronic kidney disease receiving renal replacement therapy through autologous arteriovenous fistula in the left thoracic limb and later kidney transplant from a cadaveric donor. His condition began with occasional mild pain at the level of the arm and forearm of the left thoracic limb, which progressed in intensity, partially limiting mobility and adding edema from the antecubital fold yo the distal point. He reported two isolated episodes of hypothermia and paresthesias that resolved spontaneously. A venous Doppler ultrasound was performed, finding the path of the fistula arteriovenous vein causing dilatation of the basilic vein with a thrombus inside. It was decided to dismantle the arteriovenous fistula, finding a venous path of the basilic vein of approximately 8 cm in diameter with a thrombosed upper segment. At the 1-month follow-up, the wound was found to have healed well and the patient was reported to be asymptomatic. Conclusion: In patients with large, complex pseudoaneurysms, or with failed endovascular interventions, surgical management is the best option.

Upper extremity reconstruction following open surgical repair of giant arteriovenous fistula aneurysm: clinical case and systematic review of the literature.

Background:Nearly 30% of arteriovenous fistulas (AVFs) located in the upper extremity for hemodialysis access result in short- and long-term adverse effects, such as rupture, necessitating emergent surgical management and extensive soft-tissue reconstruction. With this systematic review, we aimed to compile all reported open surgical techniques used for complicated AVF repair in the upper extremity, the respective soft-tissue reconstructive outcomes, and vascular patency rates at final follow-up.Methods:Using Ovid Medline/PubMed databases, we conducted a review of the English-language literature on AVF aneurysm surgical management in the upper extremity, filtered for relevance to open surgical technique and outcomes in vascular patency after aneurysmal repair at long-term follow-up (≥6 months postoperatively). We include a detailed case of surgical removal of a giant AVF aneurysm and subsequent flap elevation and reconstruction of the upper extremity.Results:Of 150 articles found in the initial search, 19 (from 2010-2017) met inclusion criteria. From the reviewed studies, 675 patients underwent open surgical repair of AVF aneurysm in the upper extremity. Surgical approaches included partial-to-full aneurysm excision, interposition graft, tubularized extracellular matrix, sutured and stapled aneurysmorrhaphy, and stent graft. Rates of vascular patency at repair site ranged from 47% to 100%, with a pooled average of 78% at 6 months or longer postoperatively.Conclusions:For plastic and hand surgeons, aneurysmal ligation and excision is feasible even in severe cases and is associated with overall good vascular and soft-tissue reconstructive outcomes in the upper extremity. (www.actabiomedica.it)

A rare case of a giant arterio-venous fistula (AVF) following metastatic choriocarcinoma conditioning pulmonary embolism: multimodal transcatheter embolization using a simultaneous transarterial and transvenous approach

BackgroundChoriocarcinoma is a highly malignant tumor but with a good prognosis due to the valid response to systemic chemotherapy. We present a case of a young woman affected by a giant pelvic arterio-venous fistula following a metastatic gestational choriocarcinoma, conditioning metrorrhagia and pulmonary embolism, successfully treated by multimodal transcatheter embolization, using a simultaneous transarterial and transvenous approach.Case presentationIn a young patient affected by choriocarcinoma and metrorrhagia, a computed tomography showed a giant arterio-venous fistula, pulmonary metastases and embolism. A transfemoral diagnostic arteriography showed a giant arterio-venous fistula sustained by right and left hypogastric arteries with early opacification of the right gonadal vein and of the inferior vena cava. A transarterial embolization of the distal branches of hypogastric arteries with poly-vinyl-alcohol particles, coils and Squid was performed. A transfemoral phlebography of the right gonadal vein showed multiple thrombi, responsible of the pulmonary embolism. An Amplatzer plug via trans-jugular was finally placed at the confluence of the gonadal vein in the vena cava, to reduce arterio-venous fistula out-flow and to occlude the vein, preventing further episodes of pulmonary embolism. Metrorrhagia progressively disappeared. A second transarterial embolization combined with a complete response to systemic chemotherapy determined arterio-venous fistula resolution.ConclusionsThis was a very rare case of a giant pelvic arterio-venous fistula following choriocarcinoma in a patient symptomatic for metrorrhagia with an accidental finding of pulmonary embolism at computed tomography. A transcatheter embolization was successfully performed with different embolic materials, using a simultaneous transarterial and transvenous approach: the goal was not only to obtain metrorrhagia resolution but also to avoid a massive pulmonary embolism, a potential life threatening condition, in a young woman affected by a highly malignant tumor but with a good prognosis.

脳膿瘍を契機に発見された巨大肺動静脈瘻の一切除例

脳膿瘍を契機に発見された巨大肺動静脈瘻の一切除例

Giant coronary arteriovenous fistula between left superior pulmonary vein and left atrial appendage

A 71-year-old male patient had symptomatic paroxysmal atrial fibrillation. Computed tomography detected that coronary arteriovenous fistula originated from the coronary left circumflex …

Novel transcatheter closure of internal iliac arteriovenous malformation

Arteriovenous malformations arising from iliac arteries are rare anomalies. Percutaneous embolization of such malformations is an established therapeutic option. In this paper, we will describe a case, wherein the internal iliac artery feeding a giant arteriovenous fistula was closed using a patent ductus arteriosus (PDA) duct occluder percutaneously. The PDA duct occluder is a versatile device that can be used as an alternative to vascular plugs.

Giant Pulmonary Arteriovenous Fistula

A 16-year-old boy presented with back pain. He had no medical history. Physical examination found a cyanotic lip, clubbing, a right-anterior thrill at auscultation, but no dyspnea. Chest roentgenogram (Fig 1, left panel) and computed tomography (CT) imaging (Fig 1, right panels) revealed a contrast-enhanced mass of the middle lobe, corresponding to a giant arteriovenous fistula (9 × 7.5 × 6 cm). On a 3-dimensional CT scan (Fig2,Fig 3), a 1.6 cm-diameter-dystrophic arterial (DA) branch of the middle lobe artery and a 2 cm-diameter-dystrophic venous (DV) branch of the middle lobe vein were well identified.

An 18-cm-Large Renal Arteriovenous Fistula Treated by Nephrectomy

Idiopathic renal arteriovenous fistulas are extremely rare. They are believed to occur as the result of congenital renal artery aneurysm that erodes into an adjacent vein. We report a case of a 48-year-old man in whom we discovered fortuitously a painless mass of the right flank. Computed tomography revealed a huge renal artery aneurysm with giant arteriovenous fistula in the absence of any clinical stigmata. Given the size of the fistula and the partial destruction of the renal parenchyma, nephrectomy was successfully performed.

A Safe Surgical Approach to a giant Intrarenal Arteriovenous Fistula and Aneurysm

Received November 2008 Accepted April 2009 INTRODUCTION Giant arteriovenous fistulas (AVF) pose a challenging management problem with respect to open surgery versus endovascular interventional techniques. Endovascular techniques may not be ideal for larger fistulas and may be associated with potential risks of embolism, whilst open surgery poses the risk of uncontrollable hemorrhage.(1,2) We describe a safe surgical technique for this challenging problem.

Unilateral hemothorax in a 46 year old South Indian male due to a giant arteriovenous hemodialysis fistula: a case report

In a patient undergoing regular hemodialysis through an arteriovenous fistula access, pleural effusion is a known long term complication. However, a unilateral hemothorax is relatively uncommon. Here we report a 46 year old male, end-stage renal disease patient, on maintenance hemodialysis, who presented with a giant brachiocephalic AV fistula in his left arm and progressive breathlessness. Radiological imaging revealed a left sided pleural effusion. Ultrasound guided aspiration revealed a hemorrhagic pleural fluid. A Doppler study of the fistula revealed a high velocity blood flow through the fistula, thereby establishing the cause of the unilateral hemothorax. Ligation of the fistula resulted in complete resolution of the hemothorax. The other possible causes for hemothorax in a dialysis patient are also discussed in this case report.

Giant Arteriovenous Fistula of the Upper Extremity After Distal Radius Fracture: A Rare Complication After a Common Problem

Giant Arteriovenous Fistula of the Upper Extremity After Distal Radius Fracture: A Rare Complication After a Common Problem

Successful Surgical Repair of a Giant Arteriovenous Fistula of the Coronary Arteries

Large coronary arteriovenous fistulas (CAVF) cause severe symptoms and their repair involves the serious challenge of occluding the fistula while simultaneously preserving normal coronary flow. We present a case of a giant CAVF involving the right and left coronary arteries in a symptomatic adult patient and its successful surgical repair.

Acquired, isolated third nerve palsies in infants with cerebrovascular malformations

Purpose To report two infants with acquired, isolated third nerve palsies attributable to intracranial cerebrovascular malformations. Design Observational case report. Methods Two patients are described. Each was examined in a university-based pediatric ophthalmology and neuro-ophthalmology practice. Results An 8-month-old child presented with a pupil-involving partial left third nerve palsy because of a partially thrombosed fusiform aneurysm of the left internal carotid artery. A 3-month-old infant developed a right third nerve palsy from a giant arteriovenous fistula arising from an M2 branch of the right middle cerebral artery. Conclusion Patients younger than 8 months and 3 months with acquired, isolated third nerve palsies resulting from intracranial cerebrovascular malformations could not be found in a MEDLINE search. In conclusion, at even this young age, acquired, isolated third nerve palsies may be the initial manifestation of an intracranial aneurysm or fistula. Magnetic resonance imaging (MRI) and MRI-angiography were adequate for detecting these processes.

A proposed angiographic classification of intracranial arteriovenous fistulae and malformations

We propose an angioarchitectural classification of intracranial vascular lesions as arteriovenous, arteriolovenous and arteriolovenulous fistulae. In order to validate this classification, 99 intracranial arteriovenous lesions were reviewed in 98 patients. Arteriolovenulous fistulae included 39 isolated brain arteriovenous malformations (AVMs) and 1 AVM associated with a giant arteriovenous fistula (AVF). Arteriovenous fistulae included 8 giant AVFs of the brain, 6 vein of Galen aneurysms and 10 direct caroticocavernous fistulae. Arteriolovenous fistulae included 1 isolated brain AVM, 4 vein of Galen aneurysms and 30 dural AVMs. The angioarchitectural classification has three advantages. It is simple and accurate, with no reference to the congenital or acquired nature of the lesion. It allows separate identification of a special group, the arteriolovenous fistulae. It also indicates the endovascular approach: arteriolovenulous fistulae should be treated via the arterial route only, while arteriovenous and arteriolovenous fistulae can be treated via transarterial or transvenous approaches.