Iatrogenic Arteriovenous Fistula Research Articles

Carotid jugular arteriovenous fistula: An unusual complication of internal jugular vein catheterization in children

Central venous catheterization is essential in the management of patients requiring long-term intravenous access. Various risks during central line insertion have been described in the medical literature, including the potentially life-threatening complication of iatrogenic arteriovenous fistula (AVF). We describe a novel case of carotid jugular AVF following implanted port (BardPort® by C.R. Bard, Inc.) insertion in a pediatric oncology patient who had suffered cerebral infarct due to thromboembolism. Pediatr Blood Cancer 2012; 59: 1302-1304. © 2012 Wiley Periodicals, Inc.

Abstract No. 415: Iatrogenic femoral arteriovenous fistulas (AVFs): endovascular treatment with covered stents

Iatrogenic femoral AVFs are almost always secondary to trauma or percutaneous vascular interventions.The incidence has been increased in the contemporary practice due to the ever expanding appications of percutaneous endovascular therapies via femoral access. The consequences such as high-output cardiac failure and aneurismal degeneration require treatment, especially in patient with cardiovascular comorbidities.

Iatrogenic Subclavian Arteriovenous Fistula: Rare Complication of Plate Osteosynthesis of Clavicle Fracture

Iatrogenic subclavian arteriovenous fistula is rare and has not been reported as a complication of plate osteosynthesis of clavicle fracture. This article describes the first case of iatrogenic subclavian arteriovenous fistula caused by plate osteosynthesis. A 36-year-old man sustained a right middle clavicle fracture in an injury and underwent open reduction and internal fixation with clavicular compression plate 3 days later in a local hospital. On the second postoperative day, a pulsatile mass and thrill were detected at the right supraclavicular region. The patient was discharged 3 days postoperatively with no extra inspection. Three months later, he was admitted to our institution because the mass was getting bigger and weakness was felt in his right upper limb. Digital subtraction angiography confirmed a subclavian arteriovenous fistula. Vascular surgeons treated the patient successfully using endovascular techniques. The subclavian arteriovenous fistula was eliminated with a fully expanded stent graft, and the plate was removed simultaneously. The result was satisfactory, and the postoperative course was uneventful. This case demonstrated that subclavian arteriovenous fistula could be an iatrogenic complication of screw-and-plate osteosynthesis of clavicle fracture. The operative manipulation in the process of fracture reduction and hole drilling should be meticulous, and the screw length must be accurate. Orthopedic surgeons should be aware of this uncommon complication with plate osteosynthesis of clavicle fracture. We recommend using an endovascular surgical technique for treatment of this complication.

An Iatrogenic Coronary Arteriovenous Fistula Caused by Guidewire Trauma during Percutaneous Coronary Intervention

We report the case of a 51-year-old man who presented with worsening exertional chest pain in whom subsequent percutaneous coronary intervention resulted in a coronary arteriovenous fistula. Fortunately, the patient was stable and coronary angiography revealed resolution of the fistula 20 minutes later. This case study emphasizes the management of iatrogenic coronary perforations, depending on the type and severity of perforation, which generally involves initial conservative management. (Korean J Med 2012;82:337-340)

A Case Report of Iatrogenic Arteriovenous Fistula in the Brachial Artery

A Case Report of Iatrogenic Arteriovenous Fistula in the Brachial Artery

Arteriovenous Fistula after Femoral Artery Puncture Leading to Pulmonary Edema: The Role of Ultrasonography

Local complications of arterial puncture include hematoma, pseudoaneurysm and formation of arteriovenous fistula (AVF). The latter could cause ischemia of the particular extremity or can be hemodynamically significant especially in patients suffering from congestive heart failure. We report a case of femoro-femoral AVF after thin needle arterial puncture for blood drawing. The development of this iatrogenic AVF led to pulmonary edema. The patient stabilized completely after surgical closure of the AVF. The AVF was diagnosed by duplex Doppler ultrasonography and this method was also used for estimation of blood flow through the AVF. We discuss the role of ultrasound AVF diagnostics and the method of flow calculation.

Angioplasty and Stenting of a Jugular-Carotid Fistula Resulting from the Inadvertent Placement of a Hemodialysis Catheter: Case Report and Review of Literature

Hemodialysis catheterization through the right internal jugular vein (IJV) is widely used for mid- to long-term hemodialysis for patients with renal failure. The purpose of this report is to address a serious complication in conjunction with this procedure. This is a case report of an iatrogenic jugular-carotid fistula (JCF) and a method for rectifying such a vascular conundrum, using endovascular techniques. We describe the technique used to achieve closure of the fistula as well a review of the literature. An 82-year-old woman with history of congestive heart failure, chronic renal failure, and diabetes mellitus developed an iatrogenic arteriovenous fistula, following an attempt of canalizing the right IJV. The patient was treated using three different stents, which achieved closure of the fistula. Venous catheter misplacement into an artery is a serious complication. Early endovascular treatment should be considered for a JCF.

Iatrogenic arteriovenous fistula in the Arm in an infant: Diagnostic and therapeutic considerations

Iatrogenic arteriovenous fistulas (AVF) are well described in adults; however, this complication is rarely described and reported in infants. We report the case of a 3-month-old infant with complicated gastroschisis requiring multiple venipunctures who presented with signs and symptoms suggestive of traumatic arteriovenous fistula. Ultrasound imaging confirmed the presence of a wide-necked AVF between the brachial artery and vein. The fistula was surgically repaired. This case report describes the clinical imaging and treatment options for infants with iatrogenic AVF.

Open Surgical Repair of an Iatrogenic Popliteal Arteriovenous Fistula with Proximal Arteriomegaly: A Case Report

IntroductionThe incidence of iatrogenic arteriovenous fistulas (AVFs) has increased recently. Early diagnosis and treatment can prevent major complications such as arteriomegaly. ReportWe report the case of a 30-year-old man who presented a long-standing popliteal AFV leading to iliac and femoral arteriomegaly. Fourteen years ago, he had undergone open reduction and internal fixation for a supracondylar femur fracture. A two-phase surgery was performed successfully. In phase 1, the Kirschner wire was removed and the arterial wall defect was closed by direct suture. Phase 2 was performed to repair the arteriomegaly. DiscussionOpen repair is the best therapeutic option in this patient, although it has the risk of erectile nerve damage.

Open Surgical Repair of an Iatrogenic Popliteal Arteriovenous Fistula with Proximal Arteriomegaly: A Case Report

Introduction: The incidence of iatrogenic arteriovenous fistulas (AVFs) has increased recently. Early diagnosis and treatment can prevent major complications such as arteriomegaly. Report: We report the case of a 30-year-old man who presented a long-standing popliteal AFV leading to iliac and femoral arteriomegaly. Fourteen years ago, he had undergone open reduction and internal fixation for a supracondylar femur fracture. A two-phase surgery was performed successfully. In phase 1, the Kirschner wire was removed and the arterial wall defect was closed by direct suture. Phase 2 was performed to repair the arteriomegaly. Discussion: Open repair is the best therapeutic option in this patient, although it has the risk of erectile nerve damage. Open Surgical Repair of an Iatrogenic Popliteal Arteriovenous Fistula with Proximal Arteriomegaly: A Case ReportEJVES ExtraVol. 22Issue 6PreviewThe incidence of iatrogenic arteriovenous fistulas (AVFs) has increased recently. Early diagnosis and treatment can prevent major complications such as arteriomegaly. Full-Text PDF Open Access

Localized superficial femoral vein thrombosis coupled with iatrogenic arteriovenous fistulas presenting as pulmonary emboli

'Localized' femoral vein thrombosis (FVT) is a relatively rare condition usually associated with traumas, external compression or iatrogenic etiologies and the consequence can be pulmonary embolism. This is the case of a 46-year-old woman who presented with pulmonary emboli secondary to 'localized' superficial FVT, coupled with post-puncture arteriovenous fistulas (AVFs), two days after trans-femoral vein radio-frequency cardiac ablation. After placing a temporary IVC-filter, the AVFs were sutured directly while the residual FVT was treated conservatively. Close local monitoring and adequate medical and surgical management are mandatory to avoid possible dangerous complications, also in apparently 'low-risk' iatrogenic AVFs.

Iatrogenic arteriovenous fistula of distal greater palatine artery by gingival suture

Abstract Iatrogenic arteriovenous fistula (AVF) is rarely seen in the oral cavity, especially located on the distal greater palatine artery, which has not ever been reported before. We present a case of a 13-year-old girl who had received one simple suture over the left upper gingiva in a dental clinic which 4 days later resulted in an iatrogenic AVF with life-threatening bleeding, but was successfully treated by exploratory surgery. This case report describes our experience in managing such a complication, which was caused by a simple procedure.

Transcatheter coil embolization of an iatrogenic superior mesenteric arteriovenous fistula: Report of a case

A 37-year-old male patient presented with abdominal pain and diarrhea. Computed tomography showed a large superior mesenteric vein aneurysm. The patient had a history of Crohn's disease and underwent an ileocecal resection 7 years previously. A selective angiogram of the superior mesenteric artery revealed that a dilated branch of this artery fed directly into the superior mesenteric vein. The iatrogenic superior mesenteric arteriovenous fistula was successfully closed by transarterial coil embolization. Successful endovascular treatment for a superior mesenteric arteriovenous fistula has been recently reported; however, the complications of this new modality are not well understood. We herein review the current literature and discuss endovascular treatment.

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.

Voice Matters: Late Presentation of an Iatrogenic Vertebral Arteriovenous Fistula after Liver Transplantation in Early Childhood with Successful Endovascular Treatment

Central venous cannulation is known to be a frequent cause of iatrogenic morbidity. Children are at particular risk for anatomical reasons, especially those who require complex surgical interventions because central venous access is frequently needed before, during, and after the procedure. Immediate complications, such as failure of cannulation, pneumothorax, arterial puncture, and nerve injury, are well documented. Traumatic vertebral artery pseudoaneurysms and arteriovenous fistulas are however uncommon lesions in children. Whilst surgical fistula closure has been traditionally advocated as first-line treatment, endovascular noninvasive techniques are becoming increasingly available in childhood. We report the successful endovascular treatment of a 14-year-old girl with a large vertebro-subclavian fistula 13 years after orthotopic liver transplantation.

An iatrogenic complication of internal jugular vein catheterization for hemodialysis

Central venous catheterization is increasingly performed as a temporary vascular access for hemodialysis therapy in developing countries and it can be associated with serious complications. Iatrogenic common carotid artery-jugular vein arteriovenous fistula is a rare but serious complication of internal jugular vein catheterization for hemodialysis access. Few cases of such complication of uremic patients on hemodialysis have been reported in the literature. To report a case of iatrogenic common carotid artery-jugular vein arteriovenous fistula caused by internal jugular vein catheterization of a hemodialysis patient and its surgical repair. The iatrogenic arteriovenous fistula was repaired. Acquaintance of anatomical landmarks, careful preparation, experience of the physician and the ultrasound guidance are important factors to reduce the risk of complications during internal jugular vein catheterization. Surgical repair should be performed earlier in order to avoid the development of other serious complications.

A case of iatrogenic ilio-iliac arteriovenous fistula after percutaneous cardiopulmonary support in a patient with a tortuous iliac artery

Percutaneous cardiopulmonary support (PCPS) has repeatedly been used with success as a tool for resuscitation in various life-threatening emergencies. PCPS-related vascular injuries are common, but ilio-iliac arteriovenous fistula (AVF) formation after PCPS has not been reported so far. We experienced a case of iatrogenic ilio-iliac AVF after PCPS, in which association between iliac artery tortuosity and AVF formation was strongly suspected. This case suggests that the risk of iatrogenic iliac AVF should be considered when PCPS is performed, especially in elderly patients whose arteries are frequently tortuous.

Iatrogenic Arteriovenous Fistula as a Cause for Leg Ulcers: A Case Report

An 80-year-old man presented with painful leg ulceration due to steal phenomenon from a groin arteriovenous fistula (AVF) 10 years following a coronary angiogram. The diagnosis of the AVF was confirmed by duplex examination of the groin vessels which demonstrated characteristic flow pattern in the femoral arterial and venous system. Angiography further confirmed the site of the fistulous communication and this was managed by a covered stent graft. We discuss the incidence of AVF, risk factors for its development, relevant diagnostic investigations and management options along with strategies to reduce the incidence of AVF following percutaneous punctures.

Minimally invasive surgical procedures treating symptomatic caliceal diverticular calculi

Objective To investigate the approach and safety of minimally invasive surgical procedures treating symptomatic caliceal diverticular calculi. Methods Clinical data of 21 cases with symptomatic caliceal diverticular calculi were retrospectively reviewed. Twelve females and 9 males aged 22 to 57 years old. The average diameter of caliceal diverticulum was 3.7 cm (2.5-7.0 cm) and average diameter of calculi was 2.3 cm (0.8-3.5 cm). The patients underwent flexible ureteroscopic lithotripsy, PCNL or mPCNL, laparoscopic techniques and laparoscopy-assisted transperitoneal PCNL, respectively. Four cases underwent flexible ureteroscopic lithotripsy. PCNL (2 cases) or mPCNL(5 cases)were performed in 7 cases. Nine cases underwent laparoscopic techniques. Laparoscopyassisted transperitoneal PCNL was performed in 1 case. Results The operations were performed successfully in 21 cases. No case need to transfer to open surgery during the operation and no major complications like perforation or organic injury were noted. One case with iatrogenic arteriovenous fistula of the kidney after 1 week postoperative was cured by delayed hemorrhage 2 days later, while clinical symptoms of 2 cases with residue calculi relieved. 19 cases without residue calculi were followed up for 6 to 12 month without recurrence. Conclusions After handling indication of treatment efficiently and creating advisable therapeutic decision-making, minimally invasive surgical procedures treating symptomatic caliceal diverticular calculi appears to be effective and safe. Key words: Kidney calculi; Diverticulum; Nephrostomy,percutaneous

Endovascular management of multiple arteriovenous fistulae following failed laser-assisted pacemaker lead extraction

A woman presented for evaluation of new-onset left arm edema after failed laser-assisted pacemaker lead extraction. Initial workup demonstrated a left subclavian artery to vein arteriovenous fistula (AVF). She underwent repair of the AVF with placement of a covered stent in the subclavian artery, however, her symptoms did not completely resolve. Investigation revealed a left common carotid artery to left innominate vein AVF, which was repaired by deploying a covered stent retrograde into the left common carotid artery. Her symptoms subsequently resolved. Multiple iatrogenic AVF can be repaired endovascularly, however, a high degree of suspicion for multiple injuries should be maintained.