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Published on: April 1, 2022
Percutaneous interventions of coronary artery fistulas: a single-center experience
Ahmet Hakan Ateş1, Ahmet Kivrak2, Yusuf Ziya Şener1
1Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Insights
Percutaneous closure of coronary artery fistulas (CAFs) is a safe and effective treatment. This study shows good outcomes for patients undergoing minimally invasive CAF repair, with a low complication rate.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery fistula (CAF) is a congenital anomaly involving abnormal connections between coronary arteries and cardiac chambers or great vessels.
- While surgical repair has been the traditional approach, percutaneous closure is an emerging alternative with limited long-term outcome data.
Purpose of the Study:
- To review the experience and outcomes of percutaneous coronary artery fistula closure at a single center.
- To evaluate the safety and efficacy of different percutaneous techniques for CAF treatment.
Main Methods:
- A retrospective analysis of 39 patients who underwent percutaneous CAF intervention between January 2002 and April 2022.
- Data were collected from the hospital electronic database, focusing on patient demographics, symptoms, fistula characteristics, intervention techniques, and outcomes.
Main Results:
- The most common symptoms were angina (69.2%). Right coronary artery and left anterior descending artery were the most frequent origins, with the pulmonary artery as the main drainage site.
- Coil embolization was the most common technique. Successful percutaneous occlusion was achieved in 34 patients (87.2%).
- Complications occurred in 6 patients (15.3%), with all recovering without sequelae. Two failed cases were treated surgically.
Conclusions:
- Percutaneous closure of coronary artery fistulas is a feasible and safe option for anatomically suitable cases.
- The procedure demonstrates good short-term results and a low complication rate, supporting its role as an alternative to surgery.
Introduction:
Coronary artery fistula (CAF) is a congenital communication between the coronary artery and other vascular structures or cardiac chambers. Percutaneous CAF closure is an emerging alternative to surgery, but long-term outcome data are limited.
Aim:
To review our center's experience with percutaneous CAF closure methods.
Material And Methods:
Patients who were admitted to our department and underwent percutaneous coronary artery fistula intervention between January 2002 and April 2022 due to presence of CAF-related symptoms or complications were retrospectively analyzed. Data were obtained retrospectively from the hospital electronic database.
Results:
A total of 39 patient were included. Mean age was 57.3 ±12.5 years and 23 (59%) patients were male. The most common symptom was angina (69.2%) and 51.2% of the patients were under treatment with at least one anti-anginal agent at admission. The right coronary artery (n = 19) and left anterior descending artery (n = 19) were the most common sites of CAF origin, and the pulmonary artery (n = 22) was the main drainage site. Coil embolization was performed most frequently and occlusion via cyanoacrylate in 3 patients and detachable balloon angioplasty in 1 patient were preferred. Percutaneous occlusion was achieved in 34 cases, 2 of the 5 failed cases underwent surgical occlusion, and remaining patients were treated with anti-anginal drugs. Complications occurred in 6 (15.3%) patients and all of the patients recovered without sequelae.
Conclusions:
Coronary artery fistulas may present with different symptoms or complications and there are several techniques for percutaneous occlusion. Percutaneous closure of CAF is feasible and safe in anatomically suitable vessels, with good results at follow-up.
