A case of external iliac arteriovenous fistula and high-output cardiac failure after endovenous laser treatment of great saphenous vein

Abstract

Valvular incompetence in the great saphenous vein (GSV) is the most common cause of superficial venous insufficiency and symptomatic varicose vein development. Recently, less invasive modalities such as foam sclerotherapy, radiofrequency ablation (RFA), and endovenous laser treatment (EVLT) have gained popularity in the treatment of saphenofemoral junction and saphenous truncal incompetence over the traditional approach of surgical ligation and stripping. Here, we present the case of a 32-year-old woman who underwent EVLT and was diagnosed subsequently with ipsilateral external iliac arteriovenous (AV) fistula and high-output cardiac failure. She was stabilized medically and treated surgically with a covered stent placed in the external iliac artery with complete resolution of the fistula and cardiac failure. We reviewed the literature and discuss the complications of AV fistulae after EVLT.

Arteriovenous fistula after endovenous ablation for varicose veins

“…[5][6][7][8][9][10] The majority (73%) of these occurred following EVLA. Four out of the 11 cases (36%) occurred after ablation of the small saphenous vein (SSV), and given that GSV treatment is more common, this suggests that the risk of AVF is relatively higher following SSV ablation.…”

“…In one patient, AVFs involving common femoral and external iliac vessels resulted in symptoms of highoutput cardiac failure with severe leg swelling, dyspnea, and abdominal distension. 10 Time to detection of AVF varied in reported cases from immediate recognition of a traumatic fistula intraoperatively, 5 to 30 months following ablation. In one of our patients, an AVF was only detected at 2-year follow up.…”

Fístula arteriovenosa tras tratamiento de ablación con láser endovascular

“…de bajo débito 7 y embolizaciones de arteria de pequeño calibre 6 hasta cirugía en vasos de mayor tamaño 4,5 . En nuestro caso, se opta por la colocación de un stent recubierto, por la localización de la lesión a nivel del anillo de Hunter, la cronicidad de la dolencia y el hecho de que se tratase de una FAV de alto flujo.…”

The Incidences, Hazards, Medical Errors, and Complications Associated with Endovenous Laser Obliteration in the Patients with Varicose Veins

“…Еще один вид специфичных для ЭВЛО осложнений, возникающих в результате ошибок в технике проведения процедуры, представлен послеоперационными артериовенозными фистулами. В литературе мы обнаружили сообщения о 8 случаях артериовенозных фистул после ЭВЛО [56][57][58][59][60][61][62].…”