CASE REPORT ENDOVASCULAR AND OPEN-SURGERY TREATMENT OF IATROGENIC A-V FISTULA

Abstract

Arterio-venous (AV) fistulas represent abnormal communications between arteries and veins. AV fistulas can be congenital or acquired, trauma and iatrogenic are in the base of the etiology in acquired fistulas. We present you a case of iatrogenic AV fistula after a completed surgical intervention (microdiskectomy) in the lumbar spine.
Clinical.case
 49-year old woman was hospitalized in the Vascular surgery clinic at Heart and Brain Center of Clinical Excellence, Pleven with complaints of oedema, cyanosis and tingling sensations in left lower extremity after three completed surgical interventions in the lumbar.spine.
Computer tomography assisted angiography showed communication between the common iliac artery and common iliac vein on the left side. We assessed that the patient qualified for endovascular treatment – implantation of stent-graft in the common iliac artery. On the first day after surgery, during a control examination with ultrasound in the area of the puncture we found AV communication between common femoral artery and superficial venous varicosity. With thoughts about secondary closing of the communication, the patient was released from the hospital with visible clinical improvement. At the first control exam, we acknowledged that the AV communication still persists, the patient was hospitalized for surgical ligation of the AV fistula. The intervention was done with local anesthesia, without stay in the reanimation ward and with full range of recovery movements. On the second day, she was released with double antiplatelet therapy.

Conclusion
 AV fistulas are diseases that lead to lowering the quality of life of the patients. Deep vein thrombosis (DVT) is leading in the differential diagnosis. The accurate diagnosis determinates the method of treatment. With the evolution of endovascular techniques, this type of treatment is becoming a method of choice for AV.fistulas.