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Percutaneous closure of coronary artery fistula: long-term follow-up results
Erdogan Ilkay1, Ozlem Ozcan Celebi1, Fehmi Kacmaz2
1Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkey.
Insights
Percutaneous transcatheter closure using coils and vascular plugs effectively treats coronary artery fistulas. This minimally invasive approach demonstrated complete occlusion and no recanalization in a 4-year follow-up, proving its safety and efficacy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery fistula involves abnormal congenital connections between coronary arteries and cardiac chambers or vessels.
- Complications include shunts, endocarditis, myocardial infarction, and coronary aneurysms.
- Percutaneous transcatheter techniques are emerging as alternatives to surgical closure.
Purpose of the Study:
- To evaluate the angiographic outcomes of transcatheter closure for coronary artery fistula.
- To assess the safety and efficacy of this minimally invasive treatment.
Main Methods:
- A series of 20 patients with significant coronary artery fistula underwent transcatheter closure.
- Coils and vascular plugs were utilized between March 2008 and June 2012.
- Angiographic and CT angiography assessments were performed for outcomes and follow-up.
Main Results:
- Twenty patients (14 male, mean age 53 years) with fistulas ranging from 4-12 mm were treated.
- An average of three coils were deployed per procedure, achieving complete occlusion in all cases.
- Follow-up of 4 years showed no recanalization on control CT angiography.
Conclusions:
- Transcatheter closure of coronary artery fistula is a safe and effective treatment.
- This percutaneous approach offers a viable alternative to surgical intervention.
- Long-term follow-up confirms the durability of the closure.
Introduction:
Coronary artery fistula consists of abnormal congenital connections between a coronary artery and cardiac chambers, a coronary vessel or an intrathoracic vessel that can be complicated by intracardiac shunts, endocarditis, myocardial infarction, or coronary aneurysms. Recent reports have emphasized the efficacy of percutaneous transcatheter techniques as an alternative to surgical closure, but the reported experience is relatively limited.
Aim:
To assess angiographic outcomes in a series of 20 patients who underwent transcatheter closure of coronary artery fistula.
Material And Methods:
We evaluated all patients presenting with significant coronary artery fistula and undergoing transcatheter closure with coils and a vascular plug between March 2008 and June 2012.
Results:
There were 20 patients (14 men; mean age: 53 ±8 years) with coronary artery fistula. Fistula diameter ranged from 4 to 12 mm; an average of three coils were used in the percutaneous procedure. Post-deployment angiograms demonstrated complete occlusion in all patients. The patients were followed up for 4 ±1.6 years. The control coronary computed tomographic angiography was performed in the sixth month and no patients had recanalization of the embolized vessel.
Conclusions:
Percutaneous closure of coronary artery fistula is a safe and effective treatment modality.
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