591/1992. Computed tomography of primary aortocaval fistula. Spontaneous aortocaval fistula is a rare but documented complication of arteriosclerotic abdominal aortic aneurysm. Most cases reported have presented clinically with a palpable aneurysm, abdominal bruit, and high output congestive heart failure. A diagnosis in such cases requires active demonstration of findings secondary to arteriovenous shunting, which can be optimized utilizing proper CT bolus technique and dynamic scanning. We describe several CT findings--all of which may be typical for and support the diagnosis of this potentially lethal complication of abdominal aortic aneurysm. ( info) |
592/1992. Transcatheter closure of aortocaval fistula with the amplatzer duct occluder. PURPOSE: To report percutaneous closure of aortocaval fistulas with the Amplatzer Duct Occluder. case reports: An aortocaval fistula was diagnosed after surgical repair of an abdominal aortic aneurysm in a 73-year-old man. A 3-year-old girl was treated for a congenital aortocaval fistula in another case. An 8 x 6-mm Amplatzer Duct Occluder was introduced via a 6-F introducer in each case, successfully occluding the fistulous track. Both patients are well and without any echocardiographic evidence of a shunt at 6 months. CONCLUSIONS: In selected patients, transcatheter closure of aortocaval fistula with the Amplatzer Duct Occluder could be an alternative to open surgery. Further evaluation is necessary. ( info) |
593/1992. Abdominal aortic aneurysm with aortocaval fistula and a separate retroperitoneal rupture. The occurrence of an aortocaval fistula (ACF) secondary to an abdominal aortic aneurysm (AAA) is uncommon and is often undiagnosed prior to AAA repair. Clinical signs may be subtle or absent; therefore, diagnosis requires a high suspicion and knowledge of this phenomenon. We present a case of the rarest form of ACF (type 4) in which an AAA and an occult ACF were associated with a second site of retroperitoneal rupture. The ruptured AAA and ACF were successfully managed with fistula ligation and aortic graft placement. ( info) |
594/1992. Intraoperative color Doppler sonography in the surgical treatment of perimedullary arteriovenous fistula--case report. A 36-year-old female was treated for a perimedullary arteriovenous fistula (AVF) using intraoperative color Doppler sonography monitoring. color Doppler sonography before interruption of the fistulous point clearly demonstrated an abnormal hyperechoic lesion. After interruption of the shunting point, the lesion had disappeared. Intraoperative angiography confirmed the disappearance of the perimedullary AVF. Intraoperative color Doppler sonography is a noninvasive, reliable, and cost-effective method for monitoring the effect of interruption on perimedullary AVF. ( info) |
595/1992. Rare case of pulmonary arteriovenous fistula simulating residual defect after transcatheter closure of patent foramen ovale for recurrent paradoxical embolism. We report on a patient suffering from recurrent cerebrovascular events despite previous transcatheter closure of persistent foramen ovale (PFO) with a Helex occluder. There was evidence of persistent left-to-right atrial shunt shown by transesophageal contrast echocardiography and the patient was admitted to our institution for interventional closure of the supposed residual defect. However, the PFO was completely closed by the device and left pulmonary artery injections showed a pulmonary arteriovenous fistula in the left lower lobe. This rare malformation may well explain the recurrent paradoxical embolism. Transcatheter fistula closure with coils was performed successfully. This case underlines that the existence of an isolated pulmonary arteriovenous fistula as a right-to-left shunt in patients with cryptogenic stroke should not be overlooked, even if a PFO is present and pulmonary arteriovenous fistula is not suggested by the initial physical findings or chest X-ray. ( info) |
596/1992. Unusual presentation of myocardial ischemia after arterial switch operation. Ischemic changes and acute or subacute cardiac failure after arterial switch operation generally results from imperfect transfer of coronary arteries to the neoaorta. Peroperative and early postoperative myocardial ischemia is the main cause of death in these patients. We present an unusual cause of myocardial ischemia and cardiac failure after arterial switch: a congenital coronary artery fistula between the circumflex artery and the right ventricle. The symptoms imitate coronary translocation failure. In differential diagnosis of the coronary perfusion problems encountered after the arterial switch operation, coronary artery fistula should not be forgotten, although it is rare. ( info) |
597/1992. aorta-left renal vein fistula in a woman. Spontaneous rupture of an abdominal aortic aneurysm into a retroaortic left renal vein is an uncommon occurrence. A 55-year-old woman presented with shortness of breath, vomiting, and diffuse abdominal pain that had radiated to her back and legs for the preceding 10 days. A pulsatile abdominal mass, hematuria, renal insufficiency, and heart failure were present at the initial evaluation. Computed tomography showed an infrarenal abdominal aortic aneurysm that communicated with a retroaortic left renal vein. After urgent surgical repair, cardiac and renal function were dramatically improved. To the best of our knowledge, this is the 1st reported case of a woman with such a fistula. We review treatments reported in the literature. ( info) |
598/1992. Embolization of an acute renal arteriovenous fistula following a stab wound: case report and review of the literature. Surgery has traditionally been the definitive form of invasive management for renal vascular injuries. There is a growing trend in the use of endovascular techniques as an alternative to surgery in the trauma setting. We present the case of a 24-year-old woman with an acute renal arteriovenous fistula caused by a stab wound in the left flank, which was successfully managed with selective arterial embolization. This represents only the second reported case of such an approach in the acute setting. ( info) |
599/1992. An arteriovenous fistula between the internal mammary artery and the pulmonary vein following blunt chest trauma. A 67-year-old man suffered a traffic accident and was transferred to an emergency hospital close to the scene. He was diagnosed to have bilateral pneumohemothorax with a lung contusion, an anterior fracture dislocation of the C6-vertebra and a cervical cord injury at the level of C7. On the 48th day, massive hemoptysis was suddenly recognized. He was transferred in a state of shock to our hospital to undergo hemostasis for the bleeding. On the day of admission, a selective arteriogram showed extravasation from the left bronchial artery, for which embolization was carried out using Gelfoam. In spite of this treatment, his hemoptysis continued. On the next day, a selective left internal mammary arteriogram showed an arteriovenous fistula between the left internal mammary artery and the left pulmonary vein without any apparent extravasation. The arteriovenous fistula was successfully embolized using platinum fiber coils. The patient no longer demonstrated any hemoptysis after embolization. ( info) |
600/1992. Coronary artery fistulas: case report and review of literature. Congenital coronary artery fistula is a very rare malformation that may involve any or all coronary artery branches and any cardiac chamber. Elective closure of coronary artery fistulas by surgery or percutaneous transcatheter techniques is generally accepted in the presence of symptoms, but controversies exist in the management of asymptomatic patients. We describe a case where a fistulous communication was present between the proximal left anterior descending coronary artery and the pulmonary artery and provide a review of the available literature concerning management of patients with coronary artery fistulas. ( info) |