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Arteriovenous fistula of internal mammary artery after median sternotomy
1Hartford Hospital, CT.
Insights
A rare arteriovenous fistula developed after coronary artery bypass surgery. This complication, linked to sternotomy wires, required surgical repair after embolization failed.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Medical Complications
Background:
- Median sternotomy is a common surgical approach for coronary artery bypass grafting (CABG).
- Postoperative complications, though infrequent, can arise from surgical procedures.
Observation:
- A continuous murmur was detected one month post-CABG in a female patient.
- The murmur was associated with a suspected vascular anomaly.
Findings:
- Selective angiography confirmed an arteriovenous fistula involving the right internal mammary artery and adjacent veins.
- Initial embolization treatment was unsuccessful.
- Surgical ligation and excision of the fistula were performed.
Implications:
- Parasternal wire placement during sternotomy closure is a potential cause of iatrogenic arteriovenous fistulas.
- Early diagnosis and surgical intervention are crucial for managing such vascular complications.
- This case highlights the importance of vigilant postoperative monitoring for rare complications.
Abstract:
A female patient who had undergone median sternotomy for coronary artery bypass was found to have a continuous murmur on examination one month postoperatively. An arteriovenous fistula involving the right internal mammary artery, thymic, and second intercostal veins was diagnosed with selective angiography. An attempt at embolization of the fistula failed. Therefore, ligation and excision of the fistula was carried out. The etiology was attributed to parasternal wire placement during closure of the median sternotomy.