Transcatheter Embolization Treatment of Coronary Arteriovenous Fistulas

2003 ◽  
Vol 11 (1) ◽  
pp. 63-67
Author(s):  
Ümrah Aydogan
Keyword(s):  
Arteriovenous Fistula ◽  
Surgical Intervention ◽  
Transcatheter Embolization ◽  
Transcatheter Occlusion ◽  
Surgical Ligation ◽  
Arteriovenous Fistulas ◽  
Coronary Arteriovenous Fistula ◽  
Embolization Treatment ◽  
Valve Insufficiency

Transcatheter coronary arteriovenous fistula occlusion was performed in 5 children with a median age of 5.3 years (range, 0.7 to 11 years). Surgical ligation had been carried out previously in one case, but recanalization occurred during follow-up. Dilation of the feeding artery was observed in 4 patients, with an additional aneurysm of the coronary artery in one of these. Occlusion was attempted three times in 1 patient, twice in 2, and once in the other 2. Detachable balloons were used in 2 procedures, and controlled-release coils in 3. Complete occlusion of the fistula was achieved in 4 patients. In the 5th patient, occlusion of one of two fistulas was unsuccessful, and mild to moderate aortic valve insufficiency developed due to catheter manipulation. Our experience indicates that transcatheter occlusion of congenital coronary arteriovenous fistula is at least as successful as surgical intervention. Multiple occlusion procedures can be avoided by selecting the optimal technique in each case.

Assessing the rate, natural history, and treatment trends of intracranial aneurysms in patients with intracranial dural arteriovenous fistulas: a Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) investigation

2021 ◽  
pp. 1-10
Author(s):  
Isaac Josh Abecassis ◽  
R. Michael Meyer ◽  
Michael R. Levitt ◽  
Jason P. Sheehan ◽  
Ching-Jen Chen ◽  
...  
Keyword(s):  
Natural History ◽  
Arteriovenous Fistula ◽  
Outcomes Research ◽  
Intracranial Aneurysms ◽  
Dural Arteriovenous Fistula ◽  
Aneurysm Rupture ◽  
External Carotid ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas

OBJECTIVE There is a reported elevated risk of cerebral aneurysms in patients with intracranial dural arteriovenous fistulas (dAVFs). However, the natural history, rate of spontaneous regression, and ideal treatment regimen are not well characterized. In this study, the authors aimed to describe the characteristics of patients with dAVFs and intracranial aneurysms and propose a classification system. METHODS The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database from 12 centers was retrospectively reviewed. Analysis was performed to compare dAVF patients with (dAVF+ cohort) and without (dAVF-only cohort) concomitant aneurysm. Aneurysms were categorized based on location as a dAVF flow-related aneurysm (FRA) or a dAVF non–flow-related aneurysm (NFRA), with further classification as extra- or intradural. Patients with traumatic pseudoaneurysms or aneurysms with associated arteriovenous malformations were excluded from the analysis. Patient demographics, dAVF anatomical information, aneurysm information, and follow-up data were collected. RESULTS Of the 1077 patients, 1043 were eligible for inclusion, comprising 978 (93.8%) and 65 (6.2%) in the dAVF-only and dAVF+ cohorts, respectively. There were 96 aneurysms in the dAVF+ cohort; 10 patients (1%) harbored 12 FRAs, and 55 patients (5.3%) harbored 84 NFRAs. Dural AVF+ patients had higher rates of smoking (59.3% vs 35.2%, p < 0.001) and illicit drug use (5.8% vs 1.5%, p = 0.02). Sixteen dAVF+ patients (24.6%) presented with aneurysm rupture, which represented 16.7% of the total aneurysms. One patient (1.5%) had aneurysm rupture during follow-up. Patients with dAVF+ were more likely to have a dAVF located in nonconventional locations, less likely to have arterial supply to the dAVF from external carotid artery branches, and more likely to have supply from pial branches. Rates of cortical venous drainage and Borden type distributions were comparable between cohorts. A minority (12.5%) of aneurysms were FRAs. The majority of the aneurysms underwent treatment via either endovascular (36.5%) or microsurgical (15.6%) technique. A small proportion of aneurysms managed conservatively either with or without dAVF treatment spontaneously regressed (6.2%). CONCLUSIONS Patients with dAVF have a similar risk of harboring a concomitant intracranial aneurysm unrelated to the dAVF (5.3%) compared with the general population (approximately 2%–5%) and a rare risk (0.9%) of harboring an FRA. Only 50% of FRAs are intradural. Dural AVF+ patients have differences in dAVF angioarchitecture. A subset of dAVF+ patients harbor FRAs that may regress after dAVF treatment.

Transcatheter embolization of congenital coronary arterial fistulas in adults

1999 ◽  
Vol 9 (4) ◽  
pp. 371-376 ◽  
Author(s):  
Antônio M. Kambara ◽  
Carlos A. C. Pedra ◽  
C,sar A. Esteves ◽  
Manoel N. Cano ◽  
Sérgio L. N. Braga ◽  
...  
Keyword(s):  
Bronchial Artery ◽  
Transcatheter Embolization ◽  
Pulmonary Trunk ◽  
Circumflex Artery ◽  
Catheterization Laboratory ◽  
Transcatheter Occlusion ◽  
Acceptable Alternative ◽  
The Right ◽  
Guiding Catheter

AbstractIn this report, we describe our experience with transcatheter occlusion of congenital coronary arterial fistulas in adults. From November 1992 to November 1996, 5 symptomatic patients, aged from 47 to 70 years, underwent transcatheter occlusion of fistulas using a retrograde arterial approach. All had chest pain or dyspnea on exertion. Detachable balloons were used in 4 patients, and Gianturco coils in 1. Detachable balloons were implanted through a Debrun system, while the coils were implanted through a 5 French right coronary Judkins catheter. Both were passed through an 8 French guiding catheter (Amplatz II). Each patient had a single fistula. The fistulas originated from the right coronary artery in 3 patients, and from the circumflex artery in 2. They drained into the pulmonary trunk in 3 patients, into the right atrium in 1, andinto a bronchial artery in the other. All fistulas were occluded completely in the catheterization laboratory, and the procedures were uncomplicated. At follow up, 3 patients underwent coronary angiography, and there was no evidence of recanalization. Transcatheter embolization in adults of single congenital coronary fistulas with detachable balloons and coils is safe and effective and can be regarded as an acceptable alternative to surgery.

Paraplegia due to posttraumatic pelvic arteriovenous fistula treated by surgery and embolization

1979 ◽  
Vol 50 (6) ◽  
pp. 805-810 ◽  
Author(s):  
Daniel N. Weingrad ◽  
John L. Doppman ◽  
Paul B. Chretien ◽  
Giovanni Di Chiro
Keyword(s):  
Arteriovenous Fistula ◽  
Arteriovenous Malformations ◽  
Transcatheter Embolization ◽  
Venous System ◽  
Combined Approach ◽  
Content Type ◽  
Shunt Flow ◽  
Surgical Ligation ◽  
Fine Print

✓ A case is presented in which a posttraumatic pelvic arteriovenous fistula caused progressive paraplegia because of voluminous shunting into the epidural venous system. Surgical ligation and transcatheter embolization of major and minor arterial feeders decreased shunt flow sufficiently to permit direct embolization of the fistula by an injectable plastic. This combined approach may allow obliteration of unresectable acquired or congenital arteriovenous malformations.

scholarly journals Creating percutaneous radiocephalic arteriovenous fistulas at the wrist

2020 ◽  
pp. 112972982093373
Author(s):  
Alexandros Mallios ◽  
Peter R Nelson ◽  
Gilbert Franco ◽  
William C Jennings
Keyword(s):  
Arteriovenous Fistula ◽  
Late Complications ◽  
Dialysis Therapy ◽  
Arteriovenous Fistulas ◽  
Post Procedure ◽  
Construction Techniques ◽  
Vein Diameter ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation

Background: The first arteriovenous fistulas were created at the wrist more than 60 years ago. Basic surgical construction techniques remain unchanged with mobilization and repositioning of the vessels followed by a sutured anastomosis. We used the Ellipsys device to construct percutaneous radiocephalic–arteriovenous fistulas at the wrist and report the results. Methods: Data were reviewed retrospectively for all patients who had a percutaneous radiocephalic–arteriovenous fistula created during a 6-month period. Each individual underwent ultrasound vessel mapping in addition to physical examination. When a radiocephalic–arteriovenous fistula was feasible and a communicating vein ⩾ 2 mm in diameter was noted in the distal forearm along with a radial artery ⩾ 2 mm, a percutaneous radiocephalic–arteriovenous fistula was considered and reviewed with the patient. Results: Four individuals met the criteria to consider a percutaneous radiocephalic–arteriovenous fistula and all elected to have the procedure performed. Ages were 54–85 years. Three were diabetic and one was female. All percutaneous radiocephalic–arteriovenous fistulas were technically successful. Two individuals had not yet started dialysis therapy. Successful and repetitive cannulation for the two individuals with catheters was initiated at 4 and 8 weeks post procedure. The two pre-dialysis patients had physiologic arteriovenous fistula maturation (6 mm vein diameter and >500 mL/min flow) at 4 and 12 weeks. There were no procedural or late complications and none required intervention. Follow-up was 8–23 months (mean 16 months). Conclusion: The success of these percutaneous radiocephalic–arteriovenous fistulas suggests that use of the Ellipsys device will be applicable at the wrist in selected patients where appropriate vessel sizes and configurations are found.

scholarly journals Direct percutaneous transorbital puncture under fluoroscopic guidance with a 3D skull reconstruction overlay for embolisation of intraorbital and cavernous sinus dural arteriovenous fistulas

2015 ◽  
Vol 21 (3) ◽  
pp. 357-361 ◽  
Author(s):  
Ming Lv ◽  
Chuhan Jiang ◽  
Dong Liu ◽  
Zhiguang Ning ◽  
Jun Yang ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Dural Arteriovenous Fistula ◽  
Three Dimensional ◽  
Fluoroscopic Guidance ◽  
Superior Orbital Fissure ◽  
Arteriovenous Fistulas ◽  
Skull Reconstruction ◽  
Dural Arteriovenous Fistulas

Objective To describe the direct percutaneous transorbital puncture technique for embolisation of the selected intraorbital and cavernous sinus dural arteriovenous fistula, which failed to be treated by conventional endovascular techniques. Methods One case of intraorbital and five cases of cavernous sinus dural arteriovenous fistula were embolised through direct percutaneous transorbital puncture in 2012, and the clinical data were reviewed. Under fluoroscopic guidance with a three-dimensional (3D) skull reconstruction overlay, the cavernous sinus or ophthalmic vein was punctured via the superior orbital fissure. Then a microcatheter was inserted via the needle, and Onyx was injected to embolise the fistula with or without a combination of coils. Results Complete obliteration of the fistula was achieved in all six patients. After operation all the patients experienced transient swelling of the punctured orbit persisting for three to five days. No other complications occurred. Follow-up of six patients at three to six months showed resolution of their initial neuro-ophthalmological symptoms in five and left visual loss in one did not recover. Six months follow-up angiogram showed no recurrence of these fistulas. Conclusion Direct percutaneous transorbital puncture provides an option for the intraorbital and cavernous sinus dural arteriovenous fistulas, particularly when the conventional transvenous routes are inaccessible. Overlay of the 3D skull reconstruction can facilitate the precise puncture of the superior orbital fissure.

Idiopathic renal arteriovenous fistula treated by transcatheter embolization

2005 ◽  
Vol 46 (4) ◽  
pp. 368-370 ◽  
Author(s):  
C. E. Giavroglou ◽  
T. M. Farmakis ◽  
D. Kiskinis
Keyword(s):  
Arteriovenous Fistula ◽  
Clinical Manifestations ◽  
Transcatheter Embolization ◽  
High Flow ◽  
Endovascular Management ◽  
Renal Arteriovenous Fistula ◽  
Therapeutic Technique ◽  
Arteriovenous Fistulas

Renal arteriovenous fistulas (RAVFs) are unusual lesions with a variety of clinical manifestations. Traditionally, these lesions have been treated surgically. We report on an idiopathic, high‐flow RAVF and an aneurysm treated successfully with the embolization technique. The endovascular management of RAVFs in carefully selected patients is a safe and effective therapeutic technique.

Initial 6-month quality review of a percutaneous endovascular arteriovenous fistula program

2020 ◽  
pp. 112972982094869
Author(s):  
Sulaiman Sultan ◽  
Mark Langsfeld ◽  
LeAnn Chavez ◽  
Anna Fabre ◽  
Robin Osofsky ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Arteriovenous Fistula ◽  
Success Rate ◽  
The United States ◽  
Technical Success ◽  
Technical Success Rate ◽  
Arteriovenous Fistulas ◽  
Dialysis Center ◽  
Operative Care

Background: Percutaneous arteriovenous fistulas have recently proven successful alternatives to surgical arteriovenous fistulas with encouraging initial results. The Ellipsys Endovascular Arteriovenous Fistula System utilizing ultrasound and thermal energy has recently received approval for use in the United States. At the University of New Mexico, we developed an integrated service between Vascular Surgery, Interventional Radiology, and Interventional Nephrology for percutaneous arteriovenous fistulas utilizing Ellipsys. Methods: We performed a retrospective chart review of the initial 6 months (January 1st 2019 to July 1st 2019) of 18 percutaneous arteriovenous fistula placements to evaluate our initial technical success rate, the number of arteriovenous fistulas meeting maturation characteristics or use in dialysis, and to identify areas for quality improvement. Results: Initial technical success was achieved in 17 out of 18 arteriovenous fistulas (94.4%). Three patients did not report for any follow-up at the end of the initial 6 months. Of the remaining patients, 7 out of 15 were using their arteriovenous fistulas or meeting maturation characteristics at the end of the study (46.7%). Patient loss to follow-up/no-show (16.7%), patient not yet requiring hemodialysis (27.8%), and poor post-surgical maturation and/or need for additional maturation procedures (55.6%) were the predominate reasons for non-use. We identified improved coordination of care, early intervention, and outpatient dialysis center education as the primary areas of focus for quality improvement. Conclusion: Initial technical success rate of percutaneous arteriovenous fistulas placement was comparable to published studies. Early and aggressive secondary angiographic interventions of arteriovenous fistulas failing to meet cannulation requirements, improved coordination of post-operative care, and outpatient dialysis center education appear to be the primary targets for quality improvement.

scholarly journals Unoperated giant coronary arteriovenous fistula: a thirty-year follow-up

2016 ◽  
pp. ehw396
Author(s):  
Martin Chaumont ◽  
Philippe Unger ◽  
Nadia Debbas ◽  
Jean-Luc Vandenbossche
Keyword(s):  
Arteriovenous Fistula ◽  
Coronary Arteriovenous Fistula

scholarly journals Carpal tunnel syndrome in patients with arteriovenous fistula for haemodialysis: A narrative review of the current literature

2020 ◽  
pp. 112972982094869
Author(s):  
Yasmin Grant ◽  
Simon Freilich ◽  
Maxim D Horwitz ◽  
David Shemesh ◽  
Jeremy Crane
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Arteriovenous Fistula ◽  
Carpal Tunnel ◽  
Venous Hypertension ◽  
Complete Relief ◽  
Arteriovenous Fistulas ◽  
Tunnel Syndrome ◽  
Improved Function

The ideal choice of vascular access in patients requiring haemodialysis is an arteriovenous fistula. However, an important often under-reported complication encountered at follow-up is symptoms of tingling or numbness in the hand. This may represent carpal tunnel syndrome, impairment of the median nerve as it traverses through the carpal tunnel at the wrist by focal compression of this nerve. Contributory factors in the presence of an arteriovenous fistula may include venous hypertension and varying steal syndrome phenomena provoking micro-ischaemia. Studies that investigated the evolution of carpal tunnel syndrome in haemodialysis patients with an arteriovenous fistula revealed that the frequency of carpal tunnel syndrome associated with an arteriovenous fistula on haemodialysis ranged from 10.4% to 42.6%. An association between duration of haemodialysis with arteriovenous fistula and carpal tunnel syndrome development was also observed. Surgical release of carpal tunnel provided complete relief of paraesthesia in all treated patients in the examined, demonstrating an alleviation of symptoms and improved function of hand and quality of life in patients with an arteriovenous fistula. However, the aetiology and risk factors for development of carpal tunnel syndrome remain unclear and further studies should attempt to elucidate the pathophysiology of this occurrence in the presence of arteriovenous fistulas.

scholarly journals Drug-Coated Versus Plain Balloon Angioplasty In Arteriovenous Fistulas: A Randomized, Controlled Study With 1-Year Follow-Up (The Drecorest Ii-Study)

2018 ◽  
Vol 108 (1) ◽  
pp. 61-66 ◽  
Author(s):  
P. Björkman ◽  
E.-M. Weselius ◽  
T. Kokkonen ◽  
V. Rauta ◽  
A. Albäck ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Balloon Angioplasty ◽  
Target Lesion ◽  
Target Lesion Revascularization ◽  
Controlled Study ◽  
Technical Failure ◽  
Arteriovenous Fistulas ◽  
Randomized Controlled ◽  
Drug Coated Balloon

Background and Aims: Stenosis due to intimal hyperplasia and restenosis after initially successful percutaneous angioplasty are common reasons for failing arteriovenous fistulas. The aim of this study was to evaluate the effect of drug-coated balloons in the treatment of arteriovenous fistula stenosis. Design: Single-center, parallel group, randomized controlled trial. Block randomized by sealed envelope 1:1. Materials and Methods: A total of 39 patients with primary or recurrent stenosis in a failing native arteriovenous fistulas were randomized to drug-coated balloon (n = 19) or standard balloon angioplasty (n = 20). Follow-up was 1 year. Primary outcome measure was target lesion revascularization. Results: In all, 36 stenoses were analyzed; three patients were excluded due to technical failure after randomization. A total of 88.9% (16/18) in the drug-coated balloon group was revascularized or occluded within 1 year, compared to 22.2% (4/18) of the stenoses in the balloon angioplasty group (relative risk for drug-coated balloon 7.09). Mean time-to- target lesion revascularization was 110 and 193 days after the drug-coated balloon and balloon angioplasty, respectively (p = 0.06). Conclusions: With 1-year follow-up, the target lesion revascularization-free survival after drug-coated balloon-treatment was clearly worse. The reason for this remains unknown, but it may be due to differences in the biological response to paclitaxel in the venous arteriovenous fistula-wall compared to its antiproliferative effect in the arterial wall after drug-coated balloon treatment of atherosclerotic occlusive lesions. Trial registration: ClinicalTrials.gov NCT03036241

Sign in / Sign up

Export Citation Format

Share Document