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Inadvertent aortocoronary arteriovenous fistula after CABG : Systematic review of case reports
Author(s) -
Chen Kai,
Scridon Tudor,
Chait Robert
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28930
Subject(s) - medicine , surgery , embolization , arteriovenous fistula , complication , balloon , fistula , incidence (geometry) , artery , percutaneous , stent , optics , physics
Objective To summarize published case reports of aortocoronary arteriovenous fistula (ACAVF) after coronary artery bypass grafting surgery (CABG). Background Inadvertent ACAVF is a rare complication following CABG. However, the incidence continues to rise, and its management details and clinical outcomes have not been well described. Methods To identify all published cases of ACAVF following CABG, PubMed, EMBASE, and Scopus were searched through November 2019. We defined ACAVF as inadvertent attachment of the grafting vessel onto a cardiac vein instead of targeted coronary artery. A systematic review was performed to identify the incidence, clinical features, and management outcomes. Results A total of 48 post‐CABG ACAVF cases were gathered. Among these patients, the mean age was 61.9 years and 79.2% were men. Most common presenting symptoms were chest pain (60.4%) and dyspnea (27.1%). The average onset of symptoms was 3 years; however, 54.2% of patients developed symptoms within the first year. The majority of cases reported targeted native vessel LAD during CABG (62.5%). Of these cases, 9 (18.8%) were managed conservatively, 8 (16.7%) chose to undergo surgery including ligation of fistula and repeat CABG, and 27 (56.3%) underwent percutaneous closure. Among these patients 13 cases (27.1%) were managed with coil embolization, 5 (10.4%) with balloon embolization, 5 (10.4%) were treated with a covered stent, and 4 (8.3%) used a vascular plug. There were no reported complications following treatment in this group. Conclusions Inadvertent ACAVF are rare following CABG. Percutaneous closure was feasible and safe in treating these patients.