High output heart failure due to an iatrogenic arterio-venous fistula after lumbar disc surgery

Abstract A 39-year-old patient presented with a history of right-side heart failure (dyspnea and orthopnea), right lower extremity deep vein thrombosis, and hepatic impairment. A physical exam showed increased jugular venous pressure, hepatomegaly, and bilateral lower limb pitting edema. A computed tomography angiograph revealed an arteriovenous communication between the right iliac artery and inferior vena cava (IVC) at the level of L4/L5. The patient was diagnosed with a large arteriovenous fistula (AVF), which developed post lumbar disc surgery. Fistulas between the common iliac arteries and IVC are very rare post lumbar disc surgery. Acquired iliocaval AVF is much more difficult to treat surgically because of the risk of massive hemorrhage. The patient underwent a successful endovascular stent graft repair. The patient’s symptoms of heart failure including exertional dyspnea and orthopnea were resolved 6 months post surgery.

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Arterio-venous fistula following a lumbar disc surgery

Indian Journal of Orthopaedics ◽

10.4103/0019-5413.86418 ◽

2011 ◽

Vol 45 (6) ◽

pp. 563 ◽

Cited By ~ 1

Author(s):

ThanyaniV Mulaudzi ◽

MbokelengH Sikhosana

Keyword(s):

Lumbar Disc ◽

Lumbar Disc Surgery ◽

Disc Surgery ◽

Venous Fistula

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Underlying Causes of High Output Heart Failure

Journal of Integrative Cardiology Open Access ◽

10.31487/j.jicoa.2020.06.04 ◽

2020 ◽

pp. 1-4

Author(s):

Qiuhua Shen ◽

John B. Hiebert ◽

Janet D. Pierce

Keyword(s):

Heart Failure ◽

Neurohormonal Activation ◽

Chronic Anemia ◽

Output State ◽

Arterial Blood ◽

High Output Heart Failure ◽

Underlying Causes ◽

Venous Fistula ◽

High Output ◽

Pathophysiologic Mechanisms

In the U.S., each year, there are more than 500,000 new cases of all types of heart failure. With high output cardiac failure, there is an elevated cardiac output associated with several conditions and diseases, including obesity, chronic anemia, systemic arterio-venous fistula, hypercapnia, mitochondrial dysfunction, and hyperthyroidism. The underlying pathophysiologic mechanisms relate to a reduction in systemic vascular resistance from arterio-venous shunting or peripheral vasodilation. Often there is a decrease in systemic arterial blood pressure and neurohormonal activation leading to heart failure symptoms of dyspnea and fatigue. In a persistent high output state, patients may experience tachycardia, valvular abnormalities, and ventricular dilatation and/or hypertrophy. In this article, there is a review of high output heart failure, including the prevalence, pathophysiology, and common clinical causes of this disease.

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Percutaneous Embolization of Congenital Portosystemic Venous Fistula in an Infant with Down Syndrome

Case Reports in Vascular Medicine ◽

10.1155/2013/127023 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Pattaraporn Tanya Chun ◽

Terrence Chun ◽

Matthew Files ◽

Nghia Vo ◽

Ryan M. McAdams

Keyword(s):

Heart Failure ◽

Down Syndrome ◽

Portal Vein ◽

Vascular Malformations ◽

Male Infant ◽

Percutaneous Embolization ◽

Left Hepatic Vein ◽

High Output Heart Failure ◽

Venous Fistula ◽

High Output

Congenital intrahepatic portosystemic venous shunts are rare vascular malformations often associated with severe complications. We describe a term male infant with Down syndrome with high output heart failure secondary to a congenital arterial to portal venous fistula that was diagnosed by Doppler ultrasound. Percutaneous embolizations of the left hepatic vein, portal vein, and communicating fistulas were performed without complications, resulting in clinical improvement. A subsequent hepatic ultrasound demonstrated resolution of the pathologic fistulous communication and shunting effects.

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