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An iatrogenic coronary arteriovenous fistula causing a steal phenomenon: an intracoronary Doppler study
P Wexberg1, M Gottsauner-Wolf, K Kiss
1Department of Cardiology, Clinic for Internal Medicine II, University of Vienna, Austria. pwexberg@pop3.kard.akh-wien.ac.at
Insights
A broken guidewire during coronary artery rotablation created an arteriovenous fistula. Percutaneous coil embolization successfully closed the fistula, restoring blood flow and relieving symptoms of myocardial ischemia.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Rotablation is a common procedure for treating coronary artery disease.
- Guidewire fractures during rotablation are a known complication.
- Iatrogenic arteriovenous fistulas can lead to significant hemodynamic disturbances.
Observation:
- A 67-year-old male developed an iatrogenic aneurysmal arteriovenous fistula between the right coronary artery and the coronary sinus after guidewire fracture during rotablation.
- The patient presented with symptoms suggestive of myocardial ischemia.
- Blood flow velocity data indicated a potential steal phenomenon.
Findings:
- Successful closure of the arteriovenous fistula was achieved using Doppler wire-guided percutaneous coil embolization.
- Coronary blood flow normalized post-embolization.
- Patient's symptoms of myocardial ischemia resolved after the procedure.
Implications:
- Percutaneous coil embolization is an effective treatment for iatrogenic coronary arteriovenous fistulas.
- Arteriovenous fistulas can cause myocardial ischemia through a steal phenomenon.
- Careful management and prompt intervention are crucial for patients experiencing guidewire complications during rotablation.
Abstract:
We present the case of a 67-year-old man in whom a guidewire broke at rotablation of the right coronary artery, creating an iatrogenic aneurysmal arteriovenous fistula to the coronary sinus. Successful Doppler wire-guided fistula occlusion by percutaneous coil embolization lead to normalization of coronary blood flow and relief of the patient's symptoms. Myocardial ischemia in this patient may have been due to a steal phenomenon caused by coronary artery fistulae, as suggested by blood flow velocity data obtained before and after fistula occlusion.
