Rare Cause of Late Recurrent Angina following Coronary Artery Bypass Grafting: Iatrogenic Aortocoronary Arteriovenous Fistula Causing Coronary Steal

Abstract

Iatrogenic aortocoronary arteriovenous fistula is a very rare complication of coronary artery bypass grafting in which one of the arterial grafts inadvertently forms a fistulous tract with a cardiac vein, shunting blood from the anastomosed coronary artery. We report a patient with an iatrogenic left internal mammary artery graft to cardiac vein fistula presenting with recurrent angina three years after a three-vessel coronary artery bypass grafting.

Closure of an acquired aortocoronary venous fistula after coronary artery bypass grafting causing heart failure and stable angina: A case report

“…Acquired ACVF may result in significant morbidities such as coronary steal phenomenon, leading to myocardial ischemia, high-output heart failure, infective endocarditis, significant systemicto-pulmonary shunt, pulmonary hypertension, hemothorax caused by rupture, and cardiac tamponade. [5] Our patient demonstrated cardiac failure, cardiac angina, and increased systemic-topulmonary shunt. In our patient, since the native coronary disease was progressed and symptoms resolved after fistula occlusion concomitant with OM and RCA stenting, symptoms upon admission may be also related with the nature of the progressive disease.…”

“…Coil embolization, balloon occlusion of the fistula, stenting of the unbypassed artery, covered stent deployment either by antegrade or retrograde delivery, double-umbrella or vascular occlusion devices should be considered alternative modalities. [5] In conclusion, despite the surgical preference in aortocoronary fistula are more favorable, percutaneous interventions are feasible and safe in experienced hands.…”

“…Spontaneous closure without an intervention in two asymptomatic cases, and good response to medical treatment alone in three cases have been reported in the literature. [5] Nevertheless, ligation of the fistula and surgical re-bypassing is most commonly reported treatment option. [5] Given the high mortality and morbidity risk of redo surgery, less invasive techniques have been adopted in recent years.…”

“…[5] Nevertheless, ligation of the fistula and surgical re-bypassing is most commonly reported treatment option. [5] Given the high mortality and morbidity risk of redo surgery, less invasive techniques have been adopted in recent years. To date, various advanced percutaneous techniques have been described which are promising alternatives.…”