Acquired Arteriovenous Fistula of the Breast Following Ultrasound Guided Biopsy of Invasive Ductal Carcinoma

Abstract

Image guided large-core breast biopsies are commonly performed procedures with relatively rare complications. The majority of these complications are minor, though at times more significant vascular injuries can occur with these biopsies as demonstrated by this case. Patient developed a pulsatile vascular breast mass after an ultrasound guided breast biopsy of invasive ductal carcinoma. Sonographic evaluation of this new breast mass demonstrated this mass to represent an arteriovenous fistula (AVF). Though multiple therapies are available for an iatrogenic fistula within the breast, the AVF was surgically excised in this case as it was immediately adjacent to a known cancer.

Endovascular management of iatrogenic arteriovenous fistula of the breast

“…Aside from this present case, seven case reports were retrieved from a literature search 2‐8 . A review of the case reports confirms that AVF formation may occur with any needle procedure (core/fine needle, vacuum‐assisted removal) for any type/size of breast lesion regardless of bleeding/hematoma postprocedure.…”

“…All cases have exclusively involved needle procedures to the upper quadrants of the breast in otherwise fit/well young women (range, 27‐65 years). Two cases were an incidental finding on subsequent imaging 2,4 . All other cases re‐presented with a pulsatile mass postprocedure (range, 2 weeks‐10 months).…”

“…A rare vascular complication is arteriovenous fistula (AVF) formation. Surgical excision/ligation, observation, and ultrasound‐guided compression have been utilized in its management 2‐8 . Endovascular management may be another option.…”

Iatrogenic Arteriovenous Fistula of the breast following core-biopsy presenting in pregnancy

“…Acquired AVF of the breast is a rare occurrence. A PubMed search of the literature for iatrogenic AVF only identified 4 previous cases, none of which were in the context of pregnancy …”

“…A PubMed search of the literature for iatrogenic AVF only identified 4 previous cases, none of which were in the context of pregnancy. [4][5][6][7] Substantial physiological changes occur during pregnancy and lactation with increasing estrogen and progesterone levels stimulating growth and hypervascularity of the breasts. 8,9 Given that fibroadenoma are hormone-sensitive tumors, it is not uncommon that they increase in size during pregnancy as seen in the case of our patient (13-31 mm).…”