Iatrogenic coronary arteriovenous fistula during percutaneous coronary intervention: unique insight into intra-procedural management.
We report the case of a 69-year-old man who presented with worsening exertional angina where subsequent percutaneous coronary intervention resulted in a coronary arteriovenous fistula. Attempts to occlude the fistula using a relatively conservative management approach with acute reversal of intraprocedural heparin and prolonged balloon inflation unfortunately resulted in extensive coronary artery thrombosis without immediate resolution of the arteriovenous fistula. However, follow-up at 6 months revealed resolution of the fistula. This case study emphasizes the uncommon but potentially life-threatening complications of percutaneous coronary interventions with implications not only relating to the hazards of managing iatrogenic arteriovenous fistula, but reversing intraprocedural heparin using protamine, during any coronary angiogram.
Wilsmore
Bradley
B
Department of Cardiology, Gosford Hospital, Gosford, New South Wales, Australia.
Gunalingam
Brendan
B
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001164:Arteriovenous Fistula / Q000209:etiology* / Q000517:prevention & control*; D003331:Coronary Vessels / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control*; D007430:Intraoperative Care; D008297:Male