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Congenital arteriovenous fistulas in the chest wall
1Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.
Insights
Large congenital arteriovenous fistulas in the chest wall can cause significant symptoms. Surgical excision offers temporary relief, but recurrence is common, highlighting the need for comprehensive treatment strategies.
Area of Science:
- Vascular Surgery
- Congenital Abnormalities
- Thoracic Medicine
Background:
- Large congenital arteriovenous fistulas (AVFs) in the chest wall, particularly those originating from the subclavian area, present unique clinical challenges.
- These hemodynamically significant shunts can lead to a spectrum of systemic and local complications.
Observation:
- Three cases of patients with large, congenital, hemodynamically significant chest wall AVFs originating from the subclavian area were analyzed.
- Clinical manifestations included precordial pain, cardiac dysrhythmia, dyspnea, and intermittent upper extremity ischemia due to arteriovenous shunting.
Findings:
- A total of 19 surgical operations were performed across the three cases.
- Symptom resolution was observed after fistula excision, but symptoms recurred with fistula recurrence.
- Lasting healing was achieved in only one patient after 9 years, following extensive ligation of all chest wall fistulas and subclavian artery skeletonization.
Implications:
- The complex nature of these congenital AVFs necessitates aggressive and thorough surgical intervention.
- Recurrence of symptoms underscores the challenges in achieving complete and permanent fistula obliteration.
- Successful long-term management may require extensive surgical techniques, including complete fistula ligation and arterial skeletonization.
Abstract:
The clinical manifestations of large congenital, haemodynamically significant arteriovenous fistulas in the chest wall, originating from the subclavian area, are described in three cases and the results of surgical treatment are reported. Symptoms related to arteriovenous shunting were present in all three, with precordial pain and/or cardiac dysrhythmia, dyspnoea and intermittent painful ischaemia of the upper extremity. Altogether 19 operations were performed. The symptoms disappeared when fistulas were excised, but returned when fistula recurred. Lasting healing (9 years) was achieved in only one patient, after extensive ligation of all fistulas in the chest wall and sceletation of the subclavian artery from its proximal to its distal extent.