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Percutaneous Closure of a Femoral Arteriovenous Fistula During Transfemoral TAVI

Leire Unzue, MD, PhD;  Eulogio Garc√≠a, MD;  Rodrigo Teijeiro, MD;  Belen Rubio-Alonso, MD

 

Keywords
August 2018
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J INVASIVE CARDIOL 2018;30(8):E67-E68.

Key words: aortic stenosis, cardiac imaging, dyspnea

Arteriovenous fistulae (AVF) are uncommon complications from femoral artery cannulation during cardiac surgery and may trigger high-output heart failure. Contralateral femoral access in transcatheter aortic valve implantation (TAVI) procedures provides an easy manner to attempt vascular issues from the opposite side. 

We present the case of a patient with severe aortic stenosis and an AVF between the right superficial femoral artery and the femoral vein, in which a percutaneous closure of the AVF was performed from the contralateral side using a covered stent, immediately after TAVI. 

A 76-year-old woman with previous mitral valve replacement and tricuspid annuloplasty was admitted due to progressive dyspnea. The patient described a “harmful lump” at the right groin, with occasional claudication of the leg since the surgery. 

A severe aortic stenosis with an estimated cardiac output of 8.5 L/min was established. Given the patient’s EuroSCORE of 16.78%, a transfemoral TAVI was planned. 

Coronary angiography ruled out coronary artery disease, showing an AVF between the superficial femoral artery and the femoral vein (Figure 1; Videos 1-3). Transfemoral TAVI was performed with direct implant of a 23 mm SapienXT valve (Edwards Lifesciences) advanced through the left femoral artery. After that, percutaneous closure of the AVF was achieved implanting a Fluency stent (Bard) from the contralateral side (Figure 2; Videos 2-5).

FIGURE 1. (A) Right femoral arteriogram, showing filling of the femoral vein. (B) Three-dimensional reconstruction of the arteriovenous fistula (arrow). (C) Right femoral arteriogram during TAVI procedure. (D) Direct 23 mm Sapien XT valve implant.

FIGURE 2. (A) Right femoral arteriogram showing the arteriovenous fistula (arrow). (B, C) Contralateral advance of the Fluency stent (asterisk). (D) Final result.

View the accompanying Video Series here. 

From the Hospital Universitario Madrid Montepríncipe, Madrid, Spain. 

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted March 23, 2018. 

Address for correspondence: Dr Leire Unzue, Hospital Universitario, Madrid Montepríncipe, Madrid, Spain. Email: leireunzue@yahoo.es


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