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Iatrogenic Coronary Arteriovenous Fistula during Percutaneous Coronary Intervention: Unique Insight into Intra-Procedural Management
BRADLEY WILSMORE B.Sc. (Hons), M.B.B.S. (Hons), Ph.D.,
BRENDAN GUNALINGAM M.B.B.S., F.R.A.C.P., F.C.S.A.N.Z., F.S.C.A.I.,
BRADLEY WILSMORE B.Sc. (Hons), M.B.B.S. (Hons), Ph.D.
Department of Cardiology, Gosford Hospital, Gosford, New South Wales, Australia
Search for more papers by this authorBRENDAN GUNALINGAM M.B.B.S., F.R.A.C.P., F.C.S.A.N.Z., F.S.C.A.I.
Department of Cardiology, Gosford Hospital, Gosford, New South Wales, Australia
Search for more papers by this authorBRADLEY WILSMORE B.Sc. (Hons), M.B.B.S. (Hons), Ph.D.,
BRENDAN GUNALINGAM M.B.B.S., F.R.A.C.P., F.C.S.A.N.Z., F.S.C.A.I.,
BRADLEY WILSMORE B.Sc. (Hons), M.B.B.S. (Hons), Ph.D.
Department of Cardiology, Gosford Hospital, Gosford, New South Wales, Australia
Search for more papers by this authorBRENDAN GUNALINGAM M.B.B.S., F.R.A.C.P., F.C.S.A.N.Z., F.S.C.A.I.
Department of Cardiology, Gosford Hospital, Gosford, New South Wales, Australia
Search for more papers by this authorAddress for reprints: Brendan Gunalingam, M.B.B.S., F.R.A.C.P., F.C.S.A.N.Z., F.S.C.A.I., Department of Cardiology, Gosford Hospital, Holden Street, Gosford, NSW 2250, Australia. Fax: +61-2-43202808; e-mail: [email protected].
Abstract
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.
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