Inadvertent aortocoronary arteriovenous fistula after CABG: Systematic review of case reports

Abstract

Objective: To summarize published case reports of aortocoronary arteriovenous fistula (ACAVF) after coronary artery bypass grafting surgery (CABG). Background: Inadvertent ACAVF is a rare complication following CABG. However, the incidence continues to rise, and its management details and clinical outcomes have not been well described. Methods: To identify all published cases of ACAVF following CABG, PubMed, EMBASE, and Scopus were searched through November 2019. We defined ACAVF as inadvertent attachment of the grafting vessel onto a cardiac vein instead of targeted coronary artery. A systematic review was performed to identify the incidence, clinical features, and management outcomes. Results: A total of 48 post-CABG ACAVF cases were gathered. Among these patients, the mean age was 61.9 years and 79.2% were men. Most common presenting symptoms were chest pain (60.4%) and dyspnea (27.1%). The average onset of symptoms was 3 years; however, 54.2% of patients developed symptoms within the first year. The majority of cases reported targeted native vessel LAD during CABG (62.5%). Of these cases, 9 (18.8%) were managed conservatively, 8 (16.7%) chose to undergo surgery including ligation of fistula and repeat CABG, and 27 (56.3%) underwent percutaneous closure. Among these patients 13 cases (27.1%) were managed with coil embolization, 5 (10.4%) with balloon embolization, 5 (10.4%) were treated with a covered stent, and 4 (8.3%) used a vascular plug. There were no reported complications following treatment in this group. Conclusions: Inadvertent ACAVF are rare following CABG. Percutaneous closure was feasible and safe in treating these patients.

CTA analysis of 482 cases of coronary artery fistula: A large‐scale imaging study

“…In addition, coronary artery fistula can also be caused by acquired factors, such as trauma, cardiac surgery, myocardial biopsy, heart transplantation, infective endocarditis, coronary intervention therapy, etc 10–12 . Some studies believe that coronary artery fistula increases with the increase in the frequency of cardiovascular surgery and other treatment procedures 1 .…”

“…1 In addition, coronary artery fistula can also be caused by acquired factors, such as trauma, cardiac surgery, myocardial biopsy, heart transplantation, infective endocarditis, coronary intervention therapy, etc. [10][11][12] Some studies believe that coronary artery fistula increases with the increase in the frequency of cardiovascular surgery and other treatment procedures. 1 In this study, there was a patient after left atrial ear occlusion, but no coronary artery fistula was found by preoperative coronary angiography, and a rotatory left atrial ear fistula occurred after surgery (Figure 1).…”

Factors Influencing the Incidence of Pneumonia after Coronary Artery Bypass Grafting

“…It brings huge obstacles to the work and spirit of patients, as well as huge economic burden and labor loss to families and society [10]. Therefore, how to effectively promote the recovery of lung function of patients is also the focus of clinical intervention [11,12]. By analyzing the factors affecting pulmonary infection in patients undergoing CABG and proposing nursing measures and invasive examination methods, the occurrence of pulmonary infection can be further reduced.…”