Percutaneous occlusion of an iatrogenic aortosaphenous vein--coronary vein fistula via retrograde coronary sinus approach

Iatrogenic Aortocoronary Arteriovenous Fistula following Coronary Artery Bypass Surgery: A Case Report and Complete Review of the Literature

The case of a patient who presented with angina following a coronary artery bypass (CABG) operation during which the left internal mammary artery was inadvertently anastomosed to a cardiac vein is presented. The literature concerning previously reported cases of aortocoronary arteriovenous fistulas (ACAVF) due to inadvertent grafting of a coronary vein is reviewed and the significance of this complication is discussed. ACAVF due to inadvertent grafting of a coronary vein is a rare complication of CABG and may be a more common cause of graft failure than has previously been recognized. Distortion of cardiac anatomy, the presence of epicardial fat, and an intramyocardial course of the artery intended for grafting are predisposing factors. Some patients present with angina pectoris and heart failure whereas others have no symptoms. The diagnostic test of choice is coronary angiography. Cardiac MRI and CT have a limited role due to the smaller size and the more clearly defined course of these fistulas. Asymptomatic patients are simply observed since spontaneous closure of these fistulas is reported. Symptomatic patients can be treated with combined medical management and percutaneous methods.

Iatrogenic left internal mammary artery to great cardiac vein anastomosis treated with coil embolization

Inadvertent left internal mammary artery (LIMA)-great cardiac vein (GCV) anastomosis is a rare complication of coronary artery bypass graft surgery. Patients with iatrogenic aortocoronary fistula (ACF) were usually treated surgical repair, percutaneous embolic occlusion with coil or balloon. We report a case of iatrogenic LIMA to GCV anastomosis successfully treated with coil embolization and protected left main coronary intervention through the percutaneous transfemoral approach.

Amplatzer vascular plugs for occlusion of a left internal mammary artery graft anastomosed to the anterior interventricular vein

The authors present a case of left internal mammary artery graft anastomosis to the anterior interventricular vein leading to congestive heart failure. The patient underwent successful left main stenting using an Impella left ventricular assist device and left internal mammary graft occlusion using two Amplatzer vascular plugs.

Percutaneous treatment of an iatrogenic cardiac fistula

Coronary fistulae, defined as communications between coronary arteries and cardiac chambers or veins, are uncommon. We present a case where a fistula was inadvertently caused by the surgical anastomosis of an arterial coronary artery bypass graft to a coronary vein. This produced two coronary problems, the unrevascularized Cx territory and a coronary arteriovenous fistula, and left the patient with symptoms. Each of these problems was addressed in a tailored percutaneous intervention by deploying ostial and distal stents to revascularize the Cx, followed by coils to block the distal section of the graft.

Natural history of inadvertent aorta-saphenous vein-coronary vein bypass graft

Inadvertent distal anastomosis of an aortocoronary bypass graft to a coronary vein is a rare but potentially serious complication of coronary artery bypass surgery. We describe a patient in whom such a conduit was discovered only incidentally 17 years after its creation. This case illustrates the pertinent features of this anomaly and demonstrates that it can have a benign natural history.

Closure of an iatrogenic aortocoronary arteriovenous fistula: transcatheter balloon embolization following failed coil embolization and salvage of coils that migrated into the coronary venous system

We report a 50-year-old patient with successful percutaneous closure of a large inadvertent surgical aortocoronary arteriovenous fistula (shunt flow: 1.8 L/min). With initial embolization of multiple coils, no lasting occlusion of the large fistula could be achieved. Above that, two coils migrated into the coronary venous system. Following rescue of the migrated coils through a retrograde coronary sinus approach, the fistula was occluded using a detachable balloon. Follow-up angiograms confirmed successful closure of the fistula. In contrast to coil embolization, use of a detachable balloon seems to be the appropriate technique for percutaneous closure of such fistulas.