Endovascular embolization of symptomatic arteriovenous fistulas secondary to lower-limb in situ venous bypass grafts.
OBJECTIVE
To evaluate the safety and efficacy of endovascular treatment of symptomatic arteriovenous (AV) fistulas associated with femoropopliteal in situ venous bypass grafts.


METHODS
Twenty-one patients underwent embolization of symptomatic AV fistulas associated with lower-limb bypass with use of the saphenous vein (n = 16) or femoral vein (n = 5). The procedures were performed with microcatheters and metallic coils. Indications for embolization were venous congestion (n = 15) and arterial insufficiency (n = 6). Eight patients had persistent lower-limb edema, seven had painful inflammatory skin thickening, three had intermittent claudication, and three had nonhealing ulcers.


RESULTS
Forty-four AV fistulas were embolized. Symptoms of venous congestion regressed completely in 12 of 15 patients (80%). Partial symptom improvement was achieved in three other patients (20%), two of whom had persistent lower-limb edema and bypass with use of the femoral vein. Five of six patients with ischemic symptoms (83%) had complete symptom relief. One patient (17%) whose ischemic ulcer did not recover despite successful embolization of AV fistulas required an amputation 4 months later. Overall, 17 of 21 patients (81%) showed complete recovery of clinical symptoms. There was no bypass occlusion during follow-up (mean, 17.5 months; range, 1-45 months).


CONCLUSIONS
Embolization of symptomatic AV fistulas secondary to lower-limb in situ venous bypass is a safe and efficient alternative to surgical ligature. Complete regression of clinical symptoms is less likely when the bypass is performed with use of the femoral vein.
Department of Radiology, Hôpital Timone, Marseille, France.
Vincent
V
Vidal
Eric
E
Therasse
Alexis
A
Jacquier
Marie-France
MF
Giroux
Sébastien
S
Bommart
Jean-Michel
JM
Bartoli
Vincent L
VL
Oliva
Frédérick
F
Cohen
Jean-François
JF
Blair
Guy
G
Moulin
Michel
M
Philie
Gilles
G
Soulez
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001164:Arteriovenous Fistula / Q000209:etiology / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005268:Femoral Vein / Q000637:transplantation*; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D012501:Saphenous Vein / Q000637:transplantation*; D016896:Treatment Outcome