J Korean Med Sci.  2016 Dec;31(12):2051-2053. 10.3346/jkms.2016.31.12.2051.

Delayed High Output Heart Failure due to Arteriovenous Fistula Complicated with Herniated Disc Surgery

• Park T
• Park SH
• Arora A

• KMID: 2355638
• DOI: http://doi.org/10.3346/jkms.2016.31.12.2051

Abstract

A 36-year-old male presented with progressive exertional dyspnea over months. Physical examination showed jugular venous distension, lung crecipitations, femoral bruit and pitting pedal edema. Echocardiogram showed a dilated right ventricle with severe pulmonary hypertension and a non collapsing inferior vena cava (IVC). On right heart catheterization, IVC oxygen saturation was noted at 92% suggesting arterial mixing; a computed tomography of the abdomen showed a fistula between the right common iliac artery to the right common iliac vein at L4 level and a massive IVC; this was linked to trauma from a disectomy done 16 years ago at L4-L5 level. Endovascular sealing with a 16 × 60 mm bifurcated stent graft (S & G Biotech, Seoul, Korea) was performed which led to complete resolution of the patient's dyspnea. Iatrogenic vascular injury during lumbar disc surgery, although rare, can lead to high output cardiac failure developing over months to years.

Keyword

Arteriovenous Fistula; Herniated Disc Surgery; High Output Cardiac Failure; Endovascular Stent Graft

MeSH Terms

Abdomen
Adult
Arteriovenous Fistula*
Blood Vessel Prosthesis
Cardiac Catheterization
Cardiac Catheters
Dyspnea
Edema
Fistula
Heart Failure*
Heart Ventricles
Heart*
Humans
Hypertension, Pulmonary
Iliac Artery
Iliac Vein
Intervertebral Disc Displacement*
Lung
Male
Oxygen
Physical Examination
Seoul
Vascular System Injuries
Vena Cava, Inferior
Oxygen

Figure

• 

  Fig. 1 Computed tomography demonstrated the right common iliac artery and right common iliac venous fistula (white arrow).

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  Fig. 2 Computed tomography after the endovascular repair with the bifurcated graft placement and the resolution of common iliac arterio-venous (AV) fistula (black arrow).

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  Fig. 3 Three dimensional reconstruction computed tomography of the bifurcated graft placement and the resolution of common iliac arterio-venous (AV) fistula.

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  Fig. 4 Chest X-ray demonstrated the improvement of cardiomegaly and pulmonary congestion.

Reference

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2. Pillet JC, Pillet MC, Braesco J, Thomas E, Bezon E, Mondine PH, Barra JA, Pillet J. Vascular complications of lumbar disk surgery. Report of two cases and review of the literature on 122 cases. J Mal Vasc. 1995; 20:219–223.

3. Papadoulas S, Konstantinou D, Kourea HP, Kritikos N, Haftouras N, Tsolakis JA. Vascular injury complicating lumbar disc surgery. A systematic review. Eur J Vasc Endovasc Surg. 2002; 24:189–195.