Vascular Plug Embolization in Ilio-Caval Arteriovenous Fistula – A Case Report
R. Kishen
*
Division of Vascular Surgery, Department of Surgery, Hospital Canselor Tuanku Muhriz, National University of Malaysia, Kuala Lumpur, Malaysia.
V. Muthu
Division of Vascular Surgery, Department of Surgery, Hospital Canselor Tuanku Muhriz, National University of Malaysia, Kuala Lumpur, Malaysia.
Che Jamal
Department of General Surgery, Hospital Tuanku Ja’afar, Negeri Sembilan, Malaysia.
S. Lenny
Division of Vascular Surgery, Department of Surgery, Hospital Canselor Tuanku Muhriz, National University of Malaysia, Kuala Lumpur, Malaysia.
M. Azim
Division of Vascular Surgery, Department of Surgery, Hospital Canselor Tuanku Muhriz, National University of Malaysia, Kuala Lumpur, Malaysia and Department of General Surgery, Hospital Tuanku Ja’afar, Negeri Sembilan, Malaysia and Interventional Radiology, Department of Radiology, Hospital Canselor Tuanku Muhriz, National University of Malaysia, Kuala Lumpur, Malaysia.
N. Azuan
Interventional Radiology, Department of Radiology, Hospital Canselor Tuanku Muhriz, National University of Malaysia, Kuala Lumpur, Malaysia.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Abdominal arteriovenous fistula (AAVF) is a lethal complication, primarily of traumatic cause. A specific type of AAVF is an ilio-caval arteriovenous fistula (ICAVF). ICAVF is a life-threatening condition requiring intervention. Although open surgery and endovascular stenting are the intervention of choice, they might not suit all patients. In selected patients, where open surgery is not the best option, usage of vascular plugs can confer the benefit of treating heart failure which had resulted from the ilio-caval fistula.
Case Report: We report a case of a 35-year-old female with ICAVF complications due to lumbar disk surgery. She developed right lower limb ischemia and right heart failure due to the fistula. An initial intervention to stent and interpose graft across the fistula was unsuccessful. An alternative approach of deploying an Amplatzer Vascular Plug (AVP) instead proved to be successful. Post-intervention, the patient had a good recovery with resolution of most of her symptoms.
Conclusion: In abdominal arteriovenous fistula, AVP is an alternative approach to treat patients who fail standard endovascular graft placement. A safer and more efficient procedure, AVP is a treatment modality to be considered in a select group of patients.
Keywords: Chromosomes, aorta-iliac disease, Noctuidae, aorta-iliac diseasev, Modal Number, arterial occlusive disease, endovascular, amplatzer, embolisation