Saphenous vein graft-to-left atrium fistula treated with percutaneous transcatheter embolization with coils

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Surgical Complications

Background:

• Coronary artery fistulae (CAFs) are uncommon vascular anomalies, typically congenital, but can rarely be acquired.
• Acquired CAFs can arise from iatrogenic causes, trauma, or infections, posing diagnostic and therapeutic challenges.
• Coronary artery bypass grafting (CABG) is a potential, though rare, cause of acquired CAFs.

Observation:

• A unique case of a fistula between a coronary artery vein graft and the left atrium is presented following CABG.
• The fistula was identified and managed using a percutaneous transcatheter embolization technique.
• An unusual complication during the procedure involved the accidental loss of the embolic coil within the left atrium.

Findings:

• Successful closure of the vein graft to left atrium fistula was achieved via transcatheter embolization.
• The misplaced embolic coil was retrieved from the left atrium, resolving the procedural complication.
• This case highlights the feasibility of endovascular management for rare acquired CAFs post-CABG.

Implications:

• Percutaneous transcatheter embolization represents a minimally invasive and effective treatment option for acquired coronary artery fistulae.
• Management of misplaced embolic material during transcatheter procedures requires careful technique and retrieval strategies.
• Understanding and reporting rare complications like post-CABG fistulae contribute to improved patient outcomes and procedural safety.