Clot injection for treatment of iatrogenic femoral arteriovenous fistula after percutaneous coronary intervention: a novel minimally invasive method

Introduction

Iatrogenic arteriovenous fistula (AVF) is usually caused by inappropriate blood vessel cannulation during diagnostic and interventional procedures [1–3]. Arteriovenous fistulas occur in 1.0–1.5% of cases following procedures with femoral access (FA) [1, 4, 5]. Iatrogenic fistulas are unintentional connections between an artery and a vein due to the needle being advanced too deeply and reaching the vein lumen, resulting in a constant flow of blood between the artery and the vein. Arteriovenous fistulas sometimes coexist with pseudoaneurysms (PAS) [6, 7]. Arteriovenous fistulas are characterized by a high-gradient blood flow through the fistula from artery to vein (Figures 1 B and C). There are three types of AVF. The most frequent type is an AVF in which the fistula is only an anastomosis between the lumen of the artery and the vein. Another type is a pseudochannel varying in length between the two vessels (Figures 1 A and C). The third type is an AVF (a channel or anastomosis) with an accompanying PAS. Several therapeutic strategies have been developed to treat iatrogenic arteriovenous fistulas. Most frequently, but not in all cases, it is insertion of a stent graft [8, 9]. A rare occurrence of this complication may be the main obstacle in developing simple treatment strategies, and even large-volume interventional centres use different approaches to treat AVFs. Bearing in mind the advantages and disadvantages of the available strategies, we developed a simple, cost-effective and safe technique to treat an arteriovenous fistula with a channel-type connection.

Material and methods

This experimental study was approved by the Bioethics Committee of the Local Chamber of Physicians. Written informed consent was obtained from each patient after a detailed explanation of the procedure. All patients with a channel-type AVF were followed up for 3 weeks after the initial diagnosis. Those who had the AVF patent underwent AVF closure. A total of 6 patients were included. Basic clinical characteristics are summarized in Table I. In 4 cases AVF was between the superficial femoral artery and the great saphenous vein, and in 2 cases it was between the common femoral artery and the great saphenous vein. The length of the connection ranged from 30 to 55 mm, and it had a tortuous course. During Doppler ultrasound the proximal end of the connection, i.e. the outflow of blood from the artery to the fistula (Figure 1 B), and the distal end,...


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