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ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Periodicità: Bimestrale

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 1999 Agosto;40(4):523-5

CARDIAC PAPERS 

 CASE REPORTS

Left ­internal mam­mary ­artery to innom­i­nate ­vein fis­tula com­pli­cating pace­maker inser­tion. Treat­ment ­with endo­vas­cular trans­ar­te­rial ­coil embol­iza­tion

Anguera I., Real I.*, Morales M., Vazquez F.*, Montana X.*, Paré C.

From the Depart­ment of Car­di­ology and Vas­cular Inter­ven­tional ­Radiology*, Hos­pital ­Clinic, Uni­ver­sity of Bar­ce­lona, ­Spain

Arter­i­ov­e­nous fis­tula (AVF) is ­rarely encoun­tered as a com­pli­ca­tion of pace­maker inser­tion. Per­cut­aneous angio­graphic ­therapy of ­such iat­ro­genic fis­tulas can be ­both ­safe and effec­tive, ­leading to impor­tant reduc­tions in ­costs. A 60-­year-old ­woman was ­admitted to the hos­pital ­four ­weeks ­after ­left sub­cla­vian pace­maker inser­tion com­plaining of ­signs of con­ges­tive ­heart ­failure. A ­loud con­tin­uous ­machinery ­bruit was ­heard ­over the ­left ­upper ­chest. An arter­i­o­gram ­revealed a ­false aneu­rysm ­from the ­LIMA, 6 mm in-diam­eter, ­with for­ma­tion of an AVF ­between the ­LIMA and the ­left innom­i­nate ­vein. Embol­iza­tion of the ­LIMA was car­ried out ­using ­seven Plat­inum ­coils at the ­level of the AVF and the ­false aneu­rysm was embol­ized ­with 3 con­trolled-­release IDC ­coils. The com­plete occlu­sion of the fis­tula was ­achieved and the ­distal ­LIMA per­sisted ­patent due to the ­opening of col­lat­eral ves­sels ­from the inter­costal ­arteries. AVF ­between the sub­cla­vian ­artery or its ­branches and the sub­cla­vian or innom­i­nate ­veins ­have ­been ­reported to be con­gen­ital, trau­matic and iat­ro­genic (asso­ciated to cen­tral ­venous ­access to hemo­dy­namic mon­i­toring, dial­ysis, and ­very infre­quently to pace­maker inser­tion) but the ­internal mam­mary ­arteries are ­only ­rarely ­involved. The ­course of AVF is unde­fined, but gen­er­ally, sur­gical or per­cut­aneous embol­iza­tion is war­ranted ­because of the poten­tial appear­ance of a ­great ­number of com­pli­ca­tions. Sur­gical ­repair is asso­ciated ­with sig­nif­i­cant mor­bidity and mor­tality. When­ever pos­sible, per­cut­aneous non­sur­gical occlu­sion of the AVF ­with ­coil embol­iza­tion is the pro­ce­dure of ­choice, ­because of its ­high suc­cess ­rate and low mor­bidity.

lingua: Inglese


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