Subclavian Arteriovenous Fistula Research Articles

Iatrogenic asymptomatic subclavian arteriovenous fistula after percutaneous catheterizationcutaneous catheterization

A 4-year-old child with chronic enteropathy underwent left percutaneous internal jugular vein Hickman catheter insertion for total parenteral nutrition (TPN) under general anaesthesia. Previously this child had undergone percutaneous Hickman line insertion on the right internal jugular vein in 2013 and the right subclavian vein in 2015. These lines had been removed before due to catheter sepsis. During the present procedure, 6.6 french Hickman line was inserted into the left internal jugular vein by percutaneous peel away technique under ultrasound guidance. Later in the ward it was noticed that Hickman line was not functioning and there was reverse flow of blood into the intravenous (IV) line. Blood gas sample taken from the line showed arterial values and the catheter was subsequently removed. Computed tomography (CT) angiography was done which reported arteriovenous (AV) fistula with pseudoaneurysm of the right subclavian vein. The child was then referred to department of cardiothoracic surgery for further management. From the above case report we can infer that patients who underwent repeated percutaneous central line insertions may develop iatrogenic AV fistula or pseudo aneurysm. These complications can be asymptomatic for years. Failure to recognize this may lead to catastrophe during reinsertion. Hence proper history taking, clinical examination for bruit, thrill over the neck veins and cardiac examination should be done preoperatively if there is past history of multiple insertions. Investigations like venous blood gas sampling, USG doppler for neck veins, echocardiography, and CT angiography should be done in these cases preoperatively.

An unusual complication during implantation of an internal cardioverter-defibrillator: A Case Report

Subclavian arteriovenous fistulas are a rare but known complication of catheterisation procedures, pacemaker and internal cardioverter-defibrillator (ICD) implantation and surgery. These fistulas typically become apparent few days after procedure through clinical signs of a high output circulation. However, small fistulas can remain asymptomatic. We describe a case of a chronic Subclavian Arteriovenous Fistula (AVF) complicating an otherwise straightforward ICD device implantation procedure. The patient required urgent endovascular treatment to close the fistula.

Endovascular Management of an Acquired Subclavian Arteriovenous Fistula Secondary to Chronic Venous Occlusion after Pacemaker Insertion

Endovascular Management of an Acquired Subclavian Arteriovenous Fistula Secondary to Chronic Venous Occlusion after Pacemaker Insertion

Transcatheter closure of a congenital subclavian arteriovenous fistula using a duct occluder

Transcatheter closure of a congenital subclavian arteriovenous fistula using a duct occluder

Brachiocephalic artery & subclavian vein injury with embolization to the pulmonary vasculature

Penetrating trauma with resultant vascular injury can cause significant morbidity and mortality. In rare instances, embolization of projectiles or other foreign bodies can cause additional morbidity and present a diagnostic challenge to the treating physician. With the advent of endovascular stents, the use of minimally invasive techniques for the management of vascular injuries from penetrating trauma is increasing. We present the case of a brachiocephalic artery to subclavian vein arteriovenous fistula following a BB gunshot to the neck successfully treated with endovascular stent and non-operative management of a projectile embolus to the pulmonary arterial circulation.

Surgery for subclavian arteriovenous fistula with ruptured pseudoaneurysm using total circulatory arrest

Subclavian arteriovenous (AV) fistula is an uncommon disease and rarely occurs secondary to injury. We herein report a case of a ruptured pseudoaneurysm with a subclavian AV fistula caused by clavicle fixation. In cases of a large ruptured pseudoaneurysm with a massive surrounding hematoma, bleeding control and vessel repair is very difficult. For treatment of this case, we decided that median sternotomy and cardiopulmonary bypass with total circulatory arrest would be a good alternative to surgery.

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.

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.

Late Concomitant Pseudoaneurysm and Arteriovenous Fistula of the Subclavian Artery: A Developing Country Perspective

Concomitant subclavian artery pseudoaneurysm and arteriovenous (AV) fistula has been rarely reported. We report a case of late concomitant pseudoaneurysm and AV fistula of the subclavian artery caused by a gunshot wound. Open surgical approach with an infraclavicular approach was used; subclavian artery was repaired with a Gortex interposition graft and subclavian vein was ligated. The postoperative course was uneventful. In developing countries, where the endovascular expertise is unavailable or if the lesion is large, open surgical approach provides similar results as an endovascular approach.

Operative management of penetrating wounds of the chest in civilian practice

Although most patients with penetrating chest wounds can be managed successfully with early tube thoracostomy, blood volume replacement, and close observation, the remainder can be saved only by an aggressive operative intervention. Between July, 1972, and June, 1977, 600 patients with penetrating chest wounds were treated at the Martin Luther King, Jr./Drew Medical Center, with an over-all mortality rate of 2.2 percent. One hundred twenty-five patients required thoracotomy. They included 110 male and 15 female subjects with an average age of 29 years. Fifty-four percent had stab wounds and 46 percent gunshot wounds. On admission 92 percent were in shock. Hemothorax was the most common x-ray finding, being significant (average 1,200 ml.) in 88 percent. Fourteen patients (11 percent) had cardiac arrest before reaching the hospital. They underwent immediate thoracotomy in the emergency room, and two survived. Eighty-five percent of the deaths were due to severe cardiac wounds. Ninety-nine patients (79 percent) underwent early thoracotomy (within 24 hours), with only one death; 92 percent were operated upon within 2 hours of admission. Persistent hemorrhage was the indication in 60 percent. There were no deaths among the 24 patients with cardiac wounds who reached the operating room alive or among the 26 patients who underwent both thoracotomy and exploratory laparotomy. Other indications for early thoracotomy included pulmonary and hilar wounds and perforations of the esophagus, trachea, and major bronchi. Late thoracotomy (after 24 hours) was required in 12 patients. The indications included significant clotted hemothorax in nine, infected hemothorax in one, and subclavian arteriovenous fistula in two patients. All survived. The over-all mortality rate was 10.4 percent, but less than 1.0 percent for the 111 patients who reached us alive. The over-all complication rate was 7 percent, and the average period of hospitalization was 11.8 days.

Iatrogenic Arteriovenous Fistula: A Complication of Percutaneous Subclavian Vein Puncture

A case of iatrogenic subclavian arteriovenous fistula is reported. An intracath had been inserted percutaneously into the left subclavian vein to monitor the central venous pressure during aortic valve surgery. On the second postoperative day a thrill and continuous murmur were detected at the left subclavian region. Left subclavian arteriogram and catheterization studies confirmed the diagnosis of subclavian arteriovenous fistula. The lesion was treated surgically with satisfactory results.