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Updated: Jul 3, 2026
Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
Published on: April 1, 2022
Percutaneous treatment of an iatrogenic cardiac fistula
Mark S Patterson1, Sophia Vaina, Patrick W Serruys
1Amsterdam Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. markspatterson@doctors.net.uk
Insights
Coronary fistulae are rare abnormal connections. This case details a surgically created fistula, successfully treated with percutaneous coronary intervention, including stenting and coil embolization for optimal patient outcomes.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Coronary fistulae are uncommon communications between coronary arteries and cardiac chambers or veins.
- Surgical complications can lead to iatrogenic coronary arteriovenous fistulae.
Observation:
- A patient developed a coronary arteriovenous fistula and unrevascularized circumflex (Cx) territory after arterial coronary artery bypass grafting to a coronary vein.
- The patient presented with persistent symptoms attributed to these complications.
Findings:
- A percutaneous coronary intervention strategy was employed to address both issues.
- Ostial and distal stenting successfully revascularized the Cx territory.
- Coil embolization was used to occlude the distal portion of the graft, effectively closing the fistula.
Implications:
- Percutaneous coronary intervention offers a tailored approach for managing complex coronary artery bypass graft complications.
- This case highlights the successful treatment of an iatrogenic coronary arteriovenous fistula and associated ischemia.
- Minimally invasive techniques can effectively resolve dual coronary pathologies arising from surgical errors.
Abstract:
Coronary fistulae, defined as communications between coronary arteries and cardiac chambers or veins, are uncommon. We present a case where a fistula was inadvertently caused by the surgical anastomosis of an arterial coronary artery bypass graft to a coronary vein. This produced two coronary problems, the unrevascularized Cx territory and a coronary arteriovenous fistula, and left the patient with symptoms. Each of these problems was addressed in a tailored percutaneous intervention by deploying ostial and distal stents to revascularize the Cx, followed by coils to block the distal section of the graft.
