[Treatment of acquired arteriovenous fistulas with interventional minimally invasive techniques].

OBJECTIVE: To evaluate the efficacy and safety of the interventional techniques for treatment of acquired arteriovenous fistulas (AVF).

METHODS: Ten patients with acquired AVFs, including 4 with renal AVF, 3 with iliac AVF, and 3 with subclavian AVF, were treated with interventional procedures. The etiological factors of the AVFs were penetrating trauma in 5 cases, iatrogenic injury in 3, malignancy in 1, and intestine Crohn's disease in 1. The patients presented with peripheral venous hypertension (n = 6), local bruit (n = 10), cardiac overload (n = 10), the right cardiac failure (n = 2), and hematuria (n = 4). Three patients underwent transcatheter super-selective coils embolization and 7 underwent stent-graft placement in the involved arteries.

RESULTS: The technical success was achieved in all cases. Completion angiography documented complete exclusion of the fistulas. Minor complications occurred in 3 patients, but without significant consequences. The patients experienced immediate relief of the limb swelling, peripheral venous hyperemia, and tachycardia. The local bruit was disappeared. The cardiac overload conditions were improved significantly, which was confirmed by ultrasound scan. Renal function tests in patients with renal AVF were stable. Radioactive isotopic scan revealed that the function was preserved in the treated kidney in two patients using stent-graft placement in the renal arteries. Follow-up time ranged from 6 months to 6 years. Three patients respectively died of unrelated AVF diseases in 6, 9, and 14 months after the treatment. Re-intervention with an another stent-graft placement was performed on 2 patients with recurrence of the AVF respectively at 3 weeks and two months after the procedures. The minor stenosis was found in stent-graft 2 of patients on the follow-up angiography respectively at 6 and 8 months after the treatment. Seven patients are still alive and in good condition without further intervention.

CONCLUSIONS: Minimally invasive interventional procedures, including super-selective embolization and stent-graft exclusion, are safe and effective in the treatment of acquired arteriovenous fistulas.