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Iatrogenic coronary arteriovenous fistula during percutaneous coronary intervention: unique insight into
Bradley Wilsmore1, Brendan Gunalingam
1Department of Cardiology, Gosford Hospital, Gosford, New South Wales, Australia.
Insights
Percutaneous coronary intervention can lead to rare arteriovenous fistulas. This case highlights potential complications and spontaneous resolution of these fistulas after coronary angiography.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Exertional angina is a common symptom of coronary artery disease.
- Percutaneous coronary intervention (PCI) is a standard treatment for coronary artery disease.
- Iatrogenic arteriovenous fistulas are uncommon but serious complications of PCI.
Observation:
- A 69-year-old man developed worsening exertional angina.
- Following PCI, a coronary arteriovenous fistula (CAVF) was identified.
- Initial attempts to occlude the CAVF with heparin reversal and balloon inflation led to coronary artery thrombosis.
Findings:
- The coronary artery thrombosis did not immediately resolve the CAVF.
- Spontaneous resolution of the iatrogenic CAVF was observed at 6-month follow-up.
- Management of heparin reversal with protamine during coronary angiography carries risks.
Implications:
- This case underscores the potential for life-threatening complications during PCI.
- It highlights the challenges in managing iatrogenic CAVF and the risks associated with protamine use.
- Clinicians should be aware of these uncommon but severe sequelae of coronary angiography and intervention.
Abstract:
We report the case of a 69-year-old man who presented with worsening exertional angina where subsequent percutaneous coronary intervention resulted in a coronary arteriovenous fistula. Attempts to occlude the fistula using a relatively conservative management approach with acute reversal of intraprocedural heparin and prolonged balloon inflation unfortunately resulted in extensive coronary artery thrombosis without immediate resolution of the arteriovenous fistula. However, follow-up at 6 months revealed resolution of the fistula. This case study emphasizes the uncommon but potentially life-threatening complications of percutaneous coronary interventions with implications not only relating to the hazards of managing iatrogenic arteriovenous fistula, but reversing intraprocedural heparin using protamine, during any coronary angiogram.
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