Treatment of Iatrogenic Aortocoronary Arteriovenous Fistula with Coronary Covered Stent

Abstract

An 83-year-old man, who underwent coronary artery bypass operation of left internal mammary artery (LIMA) to left anterior descending (LAD) artery, with sequential saphenous vein to the first and second obtuse marginal (OM) branches of circumflex artery 5 years ago and coronary artery stent implantation to right coronary artery 2 months ago, was admitted to the hospital with syncope and chest pain. Aortosaphenous graft selective angiography revealed that first sequential side to side ligation was inadvertently anastomosed to left posterolateral coronary vein with resultant flow into the coronary sinus and distal end to side sequential anastomosis to OM 2 coronary artery which was filling very weakly. In order to close this iatrogenic coronary arteriovenous fistula and to supply saphenous vein flow to OM artery, we decided to implant a graft covered stent into the saphenous vein at the same session.

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

“…To the best of our knowledge, only 38 cases have been reported [1]. ACAVF can become symptomatic over the course of time.…”

Fistula between the right coronary artery and coronary sinus: a case report and literature review

“…Although echocardiography may diagnose most coronary artery fistulas because of the influence of the acoustic window or fistula size, it is occasionally not accurate for detecting certain coronary artery fistulas. However, coronary artery angiography can directly reveal the blood vessel distribution and the fistula drainage situation, which may help physicians definitely diagnose and effectively treat the coronary artery fistula ( 8 ). Therefore, we recommend that patients suspected of having a coronary artery fistula who are not clearly diagnosed by echocardiography should undergo coronary angiography.…”

State of the Art Imaging Review of Blunt and Penetrating Cardiac Trauma

“…37 Although rare, simple diagnostic or therapeutic procedures such as drainage of pleural effusions or empyema can result in misplacement of catheters into the pericardial sac or even cardiac chamber 38 (Figure 14). Fistulous communications have also been reported following cardiac surgeries in patients undergoing valvular repairs 39 (Figure 15) or in gastric surgeries 40 (Figure 16).…”