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Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
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Percutaneous Coronary Intervention-Related Iatrogenic Fistula in Acute Coronary Syndrome

Mustafa Yurtdaş1, Zeki Dogan1

  • 1Cardiology, Istanbul Atlas University, Faculty of Medicine, Istanbul Medicine Hospital, Istanbul, TUR.

Cureus
|October 2, 2024
PubMed

Insights

Iatrogenic coronary artery fistula, a rare complication of percutaneous coronary intervention, can be life-threatening. This case highlights successful management of a fistula caused by guidewire trauma using prolonged balloon inflation.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Iatrogenic coronary artery fistulas (CAFs) are uncommon but serious complications following cardiac procedures.
  • They can arise after myocardial infarction, percutaneous coronary intervention (PCI), or heart surgery.
  • Prompt diagnosis and management are vital to prevent severe outcomes like cardiac tamponade or death.

Observation:

  • This report details a case of iatrogenic CAF resulting from coronary perforation during PCI.
  • The perforation occurred due to guidewire-induced trauma, complicated by stent implantation and balloon inflation.
  • The patient presented with acute coronary syndrome (ACS).

Findings:

  • The iatrogenic CAF was successfully treated using a minimally invasive technique.
  • Prolonged balloon inflation within the implanted stent, positioned at the rupture site, achieved hemostasis.
  • This approach effectively sealed the fistula without requiring further intervention.

Implications:

  • This case demonstrates a novel and effective endovascular management strategy for PCI-induced coronary artery fistulas.
  • The technique offers a less invasive alternative to surgical repair for select cases.
  • It underscores the importance of recognizing and managing coronary perforations promptly during PCI procedures.

Keywords:
acute coronary syndromecoronary arterial fistulaiatrogenic complicationmanagementpercutaneous coronary intervention complications

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