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Arteriovenous fistulas after cardiac catheterization
R L Glaser1, D McKellar, K S Scher
1Department of Surgery, Wright State University School of Medicine, Dayton, Ohio.
Insights
Acquired arteriovenous (A-V) fistulas are a rare complication of cardiac catheterization, occurring in 0.017% of procedures. Prompt surgical intervention is recommended for these fistulas, as spontaneous closure is unlikely.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Radiology
Background:
- Acquired arteriovenous (A-V) fistulas are a rare but serious complication following cardiac catheterization.
- These fistulas can lead to significant morbidity, including congestive heart failure and limb ischemia.
Purpose of the Study:
- To determine the incidence and characteristics of acquired arteriovenous fistulas after cardiac catheterization.
- To review the management and outcomes of patients with these fistulas.
Main Methods:
- Retrospective review of seven patients treated for acquired A-V fistulas post-cardiac catheterization over a six-year period.
- Analysis of hospital records to identify fistula incidence, causes, presenting symptoms, and treatment outcomes.
Main Results:
- The incidence of A-V fistulas after 23,291 cardiac catheterizations in Dayton hospitals was 0.017%.
- Common causes included intentional puncture of adjacent artery and vein or inadvertent injury during percutaneous vascular access.
- Congestive heart failure and limb ischemia were the most frequent presenting symptoms, occurring 2-10 months post-procedure.
Conclusions:
- Acquired A-V fistulas are an uncommon complication of cardiac catheterization requiring prompt surgical correction.
- Surgical management, typically involving fistula division and vessel repair, is effective.
- Spontaneous closure of these fistulas is unlikely, necessitating timely intervention.
Abstract:
In a review of five Dayton, Ohio, area hospitals during a six-year period, seven patients who were treated for an acquired arteriovenous (A-V) fistula after cardiac catheterization were identified. Four patients had undergone cardiac studies in area hospitals, while three were studied elsewhere. The four A-V fistulas after 23,291 cardiac catheterization procedures in Dayton hospitals represented an incidence of 0.017% for this complication. Congestive heart failure and limb ischemia were the most frequent presenting symptoms that developed from two to ten months after catheterization. Intentional puncture of both the artery and vein of the ipsilateral groin for right- and left-sided heart studies was the probable cause of fistula formation in two cases. Five patients sustained inadvertent injury to both an artery and adjacent vein during percutaneous vascular access. Six A-V fistulas that involved femoral vessels were managed by division of the fistula with lateral repair of the artery and vein. An unusual communication between the right thyrocervical trunk and the internal jugular vein was handled by ligation of the affected vessels. Prompt surgical correction of this unusual complication of percutaneous vascular access is recommended as spontaneous closure is unlikely.