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.
Vidal
Vincent
V
Department of Radiology, Hôpital Timone, Marseille, France.
Therasse
Eric
E
Jacquier
Alexis
A
Giroux
Marie-France
MF
Bommart
Sébastien
S
Bartoli
Jean-Michel
JM
Oliva
Vincent L
VL
Cohen
Frédérick
F
Blair
Jean-François
JF
Moulin
Guy
G
Philie
Michel
M
Soulez
Gilles
G
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