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Transcatheter embolization in the treatment of coronary artery fistulas
J F Reidy1, R T Anjos, S A Qureshi
1Department of Radiology, Guy's Hospital, London, England.
Insights
Percutaneous transcatheter embolization effectively treats coronary artery fistulas, offering a safe and permanent solution. This minimally invasive procedure is recommended as the primary treatment option for these vascular anomalies.
Area of Science:
- Cardiology
- Interventional Radiology
- Vascular Surgery
Background:
- Coronary artery fistulas are abnormal connections between a coronary artery and a heart chamber or vessel.
- While often congenital, they can be acquired, potentially leading to symptoms like heart failure.
- Diagnosis and treatment are crucial for managing associated hemodynamic abnormalities.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous transcatheter embolization for treating coronary artery fistulas.
- To determine the long-term success rates of embolization in achieving fistula occlusion.
Main Methods:
- Seven patients (2-67 years) with coronary artery fistulas underwent embolization.
- Various techniques and materials were used, including detachable balloons and microcoils.
- Follow-up included Doppler ultrasound and coronary angiography.
Main Results:
- Successful occlusion was achieved in six out of seven patients.
- One patient had early balloon deflation due to device malfunction, resulting in a residual fistula.
- No complications were reported in any patient during the procedure.
- Long-term follow-up (4 months to 4 years) confirmed permanent occlusion in all initially successful cases.
Conclusions:
- Percutaneous transcatheter embolization is a safe and effective treatment for coronary artery fistulas.
- The procedure demonstrates high success rates and durable occlusion.
- Transcatheter embolization is the preferred treatment modality for coronary artery fistulas.
Abstract:
Seven patients with a coronary artery fistula underwent percutaneous transcatheter embolization (five were male and two female; the age range was 2 to 67 years [median 17]). Three patients were symptomatic. The left to right shunt ranged from 1.6 to 2.6:1. In six patients, the fistula was an isolated congenital anomaly; in one, it was acquired. The fistula arose from branches of the left (n = 5) and right (n = 2) coronary arteries and drained to the right ventricle (n = 2), right atrium (n = 2), coronary sinus (n = 1), pulmonary artery (n = 1) and a bronchial artery (n = 1). Different embolization techniques were used to occlude eight feeding arteries. The embolization materials included a detachable balloon (n = 3), coaxial embolization with platinum microcoils (n = 3), a combination of detachable balloon and microcoil (n = 1) and standard steel coils (n = 1). Satisfactory occlusion was achieved in six patients. In one case, the valve of the detachable balloon was damaged, resulting in early balloon deflation and a residual fistula. There were no associated complications in any patient. Follow-up investigation by Doppler ultrasound or coronary angiography 4 months to 4 years later showed that permanent occlusion was achieved in all six patients in whom embolization was initially successful. Transcatheter embolization should be considered the treatment of choice for coronary artery fistulas.