Advances in Clinical and Experimental Medicine
2018, vol. 27, nr 10, October, p. 1371–1375
Publication type: original article
Endovascular treatment of iatrogenic arteriovenous fistula of the iliac vessel
1 Department of Vascular, General and Oncologic Surgery, Copernicus Memorial Hospital, Łódź, Poland
2 Department of Radiology, Copernicus Memorial Hospital, Łódź, Poland
Background. Iatrogenic vascular injuries, due to the particular nature of such pathology, are associated with high morbidity and mortality in the postoperative period.
Objectives. The objective of this study was to present a case of non-classic approach to the therapy of iatrogenic arteriovenous fistula.
Material and Methods. We present a case of a 17-year old female patient admitted to the Department of Vascular, General and Oncologic Surgery (Copernicus Memorial Hospital, Łódź, Poland) due to an iatrogenic injury to the common iliac vein and artery, following neurosurgical intervention on the spine. Two weeks prior to admission, the patient underwent surgery in the Neurosurgery Clinic for herniated nucleus pulposus and lumbar spine scoliosis. The imaging diagnostic revealed the presence of a pseudoaneurysm of the right common iliac artery and arteriovenous fistula between the right common iliac vessels. The patient was qualified for endovascular treatment. Two self-expanding covered stents were successfully deployed. The clinical and radiological outcome of the procedure was good. The postoperative period was uneventful. The patient was discharged home on the 3rd postoperative day.
Results. The control examinations (directly after the procedure and 6, 12, 24 and 32 months thereafter) revealed full patency of the iliac vessels, as well as no recurrence of arteriovenous fistula, nor a pseudoaneurysm of the right common iliac artery. No symptoms of either chronic limb ischaemia or venous insufficiency were observed.
Conclusion. Iatrogenic vessel injury, being a complication of neurosurgical and orthopedic surgeries, may be overlooked and remain undetected both in intraand postoperative period. Modern imaging techniques allow for an adequate diagnosis of the injury and planning the treatment of arteriovenous fistula. The endovascular procedures are the method of choice in patients with arteriovenous fistulas of iliac vessels, alternative to open surgery.
iatrogenic vessel injury, arteriovenous fistula, pseudoaneurysm of the common iliac artery, endovascular treatment
- Hans SS, Shepard AD, Reddy P, Rama K, Romano W. Iatrogenic arterial injuries of spine and orthopedic operations. J Vasc Surg. 2011;53(2): 407–413.
- Kufner S, Cassese S, Groha P, et al. Covered stent for endovascular repair of iatrogenic injuries of iliac and femoral arteries. Cardiovasc Revasc Med. 2015;16(3):156–162.
- Kacem AH, Ben Amar M, Chelli H, Siala I, Frikha I. Rev Med Liege. 2006; 61(12):804–806.
- Gallerani M, Maida G, Boari B, Galeotti R, Rocca T, Gasbarro V. High output heart failure due to iatrogenic arterio-venous fistula after lumbar disc surgery. Acta Neurochir (Wien). 2007;149(12):1243–1247.
- Bürger T, Meyer F, Tautenhahn J, Halloul Z, Fahlke J. Percutaneous treatment of rare iatrogenic arteriovenous fistulas of the lower limbs. Int Surg. 1998;83(3):198–201.
- Kim JH, Ko GY, Kwon TW, Nam GB, Cho YP. Endovascular treatment of an iatrogenic large vessel arteriovenous fistula presenting as high output heart failure: A case report. Vasc Endovasc Surg. 2012;46(6): 495–498.
- Ohki T, Veith FJ. Five-year experience with endovascular grafts for the treatment of aneurysmal, occlusive and traumatic arterial lesions. Cardiovasc Surg. 1998;6(6):552–565.
- Rocha L, Dalio MB, Joviliano EE, Piccinato CE. Endovascular approach for peripheral arterial injuries. Ann Vasc Surg. 2013;27(5):587–593.
- Canaud L, Hireche K, Joyeux F, et al. Endovascular repair of aorto-iliac artery injuries after lumbar-spine surgery. Eur J Vasc Endovasc Surg. 2011;42(2):167–171.
- Kiguchi M, O’Rourke HJ, Dasyam A, Makaroun MS, Chaer RA. Endovascular repair of 2 iliac pseudoaneurysms and arteriovenous fistula following spine surgery. Vasc Endovasc Surg. 2010;44(2):126–130.
- Hanel RA, Madalozzo LE, Araújo JC, Rodrigues MA, Truite LV. Common iliac artery aneurysm as complication of lumbar disc hernia surgery. Case report. Arq Neuropsiquiatr. 1999;57(3B):890–894.
- Fruhwirth J, Koch G, Ivanic GM, Seibert FJ, Tesch NP. Vascular lesions in surgery of the hip joint. Unfallchirurg. 1997;100(2):119–123.
- Szolar DH, Preidler KW, Steiner H, et al. Vascular complications in lumbar disc surgery: Report of four cases. Neuroradiology. 1996;38(6):521–525.
- Abramovitz JN. Complications of surgery for discogenic disease of the spine. Neurosurg Clin N Am. 1993;4(1):167–176.
- Bingol H, Cingoz F, Yilmaz AT, Yasar M, Tatar H. Vascular complications related to lumbar disc surgery. J Neurosurg. 2004;100(3):249–253.
- Zhou W, Bush RL, Terramani TT, Lin PH, Lumsden AB. Treatment options of iatrogenoc pelvic vein injuries: Conventional operative versus endovascular approach – case reports. Vasc Endovasc Surg. 2004;38(6):569–573.
- Fruhwirth J, Koch G, Amann W, Hauser H, Flaschka G. Vascular complications of lumbardisc surgery. Acta Neurochir (Wien). 1996;138(8):912–916.
- Boonstra RH, van Tol CA, Coster E, Wisselink W. Two patients with initially unrecognised iatrogenic arteriovenous fistula and successful endovascular therapy following lumbar herniotomy and laparoscopic cholecystectomy. Ned Tijdschr Geneeskd. 2006;11:150(6):323–328.
- Li Y, Fu Q, Liu A, et al. A case of iatrogenic ilio-iliac arteriovenous fistula initially misdiagnosed as deep venous thrombosis. Zhong Nan Da Xue Bao Yi Xue Ban. 2014;39(11):1217–1220.
- Sin’kov MA, Murashkovskiĭ AL, Pogorelov EA, et al. Endovascular closure of iatrogenic arteriovenous anastomosis of the iliac artery and vein. Angiol Sosud Khir. 2014;20(1):80–84.
- Wang EA, Lee MH, Wang MC, Lee HY. Iatrogenic left iliac-caval fistula: Imaging and endovascular treatment. AJR Am J Roentgenol. 2004; 183(4):1032–1034.
- Huwei L, Bei D, Huan Z, Zilai P, Aorong T, Kemin C. Arteriovenous fistula complicating iliac artery pseudoaneurysm: Diagnosis by CT angiography. JBR-BTR. 2002;85(2):104–105.
- Cronin P, McPherson SJ, Meaney JF, Mavor A. Venous covered stent: Successful occlusion of a symptomatic internal iliac arteriovenous fistula. Cardiovasc Intervent Radiol. 2002;25(4):323–325.
- Davidovic LB, Kostic DM, Cvetkovic SD, et al. Aorto-caval fistulas. Cardiovasc Surg. 2002;10(6):555–560.
- Tsetis D. Endovascular treatment of complications of femoral arterial access. Cardiovasc Intervent Radiol. 2010;33(3):457–468.
- Onal B, Ilgit ET, Kosar, Akkan K, Gümüş T, Akpek S. Endovascular treatment of peripheral vascular lesions with stent-grafts. Diagn Interv Radiol. 2005;11(3):170–174.
- McPherson R, Buckenham T. Complications and great escapes: Equipment and techniques. Semin Intervent Radiol. 2014;31(4):361–369.