Cases reported "Arteriovenous Fistula"

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1/133. Carotid artery fistula after cataract surgery.

    To determine carotid cavernous fistula associated with choroidal detachment after cataract surgery. A 77-year-old woman underwent cataract surgery in both eyes. Postoperatively, proptosis and dilation of episcleral vessels in her left eye occurred and gradually increased. One month later, choroidal detachment developed in her left eye. Computed tomography showed an enlarged superior ophthalmic vein. Selected cerebral angiography showed fistulas between the megingeal branches of both the internal and external carotid arteries and the cavernous sinus. After the neurosurgical treatment, these symptoms disappeared. The development of carotid cavernous fistula after cataract surgery, as demonstrated in our patient, may be uncommon. [Ophthalmic Surg lasers 1998;30:160-162.] Carotid cavernous fistula (CCF) is an abnormal communication between the internal carotid artery and the cavernous sinus. Ocular manifestation of the fistula includes proptosis, pulsation of the globe, orbital bruit, episcleral vein dilation, and chemosis. CCF is divided into spontaneous or traumatic by cause and direct or dural by angiographic findings. To our knowledge, CCF development after cataract surgery may be uncommon. We recently examined a patient with such a condition.
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2/133. Intrahepatic arterioportal fistula: gadolinium-enhanced 3D magnetic resonance angiography findings and angiographic embolization with steel coils.

    We describe a case of a 59-year-old patient with intrahepatic arterioportal fistula secondary to blunt trauma sustained by a motor vehicle accident 36 years earlier. The fistula was demonstrated 36 years after the accident in a clinical work-up for diarrhea of 1 month's duration, using contrast enhanced three-dimensional breath-hold MRA. A communication between the dilated portal vein and dilated hepatic artery was shown at the level of distal branches. After subsequent demonstration by conventional angiography, the fistula was embolized using steel coils. Following the therapeutic intervention, the patient's diarrhea ceased.
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3/133. Nonsurgical closure of large arteriovenous fistulas.

    We report a nonsurgical closure of large postnephrectomy arteriovenous fistulas in two patients. To out knowledge, this method has not previously been attempted because of the large size of the communication and the risk of pulmonary embolization. However, the development of new embolization techniques makes a nonsurgical approach feasible and safe.
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4/133. Clinical findings in a patient with spontaneous arteriovenous fistulas of the orbit.

    PURPOSE: To report clinical and radiologic findings of a patient with spontaneous arteriovenous fistulas of the orbit. METHOD: Case report. RESULTS: A 73-year-old woman was initially examined with a 1-year history of mild proptosis of the right eye. She had no history of trauma. Neuro-ophthalmologic examination disclosed dilatation of conjunctival vessels, increased intraocular pressure, mild proptosis and bruit in the right eye, and ocular signs suggestive of carotid-cavernous sinus fistulas or orbital arteriovenous malformations. The patient exhibited dilation of the superior ophthalmic vein in enhanced computed tomography of the orbit. Selective cerebral angiography disclosed communications between branches of both ophthalmic and facial arteries and the superior ophthalmic vein in the orbit. CONCLUSION: Arteriovenous fistulas of the orbit must be considered in the differential diagnosis of carotid-cavernous sinus fistulas and arteriovenous malformations, although they are quite rare.
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5/133. Double layered autogenous vein graft patch reconstruction of the common carotid-internal jugular fistula caused by gunshot wound.

    Hereby we present a case with a common carotid-internal jugular fistula caused by gunshot wound. The patient was a 32-year old male who had an entrance hole of a bullet on his right anterior cervical area, at the C4 level with a hematoma surrounding it. The exit hole could be detected at the sublingual area. By palpation a thrill and on auscultation a souffle was noted. Neither crepitation, nor any neurologic deficit or any symptom of Horner's syndrome was present. The emergency digital subtraction angiography (DSA) showed a fistulisation to internal jugular vein (IJV) approximately 0.5 cm below the common carotid artery (CCA) bifurcation level. During the operation a hematoma and a false aneurysm was observed on the CCA. Also, proximally to the bifurcation, a communication of CCA with IJV was noted. The wall of the JJV was rather thinned and the size of the vessel had considerably enlarged. Following the evacuation of the hematoma and debridement, the integration of the artery was achieved by placing a double layered autogenous vein graft patch over the 0.5 x 1.5 cm defect. The 0.3 x 1.5 cm defect laterally over the IJV was primarily sutured. The patient was discharged on the fifth day. The control DSA taken on the twelfth day showed a perfect integration of the vessels. We considered the case noticeable due to its rather rare incidence and the double layered autogen vein patch graft reconstruction.
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6/133. Progressive myelopathy caused by dural arteriovenous fistula at the craniocervical junction--case report.

    A 68-year-old male presented an unusual dural arteriovenous fistula (AVF) located at the craniocervical junction. magnetic resonance imaging revealed dilated perimedullary veins around the spinal cord at C-1 and C-2 levels, as well as high intensity signals in the spinal cord on T2-weighted images. Vertebral angiography identified an AVF at the point where the right vertebral artery penetrates the dura. The fistula was a single and direct communication between the vertebral artery and the spinal vein. Surgical interruption of the fistula at its venous side resulted in prompt improvement of both motor and sensory signs and symptoms.
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7/133. Traumatic subclavian arteriovenous fistulae.

    Arteriovenous (A-V) fistulae can be congenital or acquired. Acquired arteriovenous fistulae are met with during war as well as civilian practice as a result of penetrating injuries causing perforation in an artery and a vein which are surrounded usually by a firm sheath like the femoral, carotid or subclavian sheath, resulting in a communication between the artery and the vein. In the past, these fistulae were treated either by ligation of the feeding artery or by quadruple ligation after waiting for the collateral circulation to develop and feed the affected limb. The goal of the modern vascular surgeon, however, is to resume vascular continuity of both artery and vein. We were recently faced with a subclavian arteriovenous fistula and aneurysm caused by a gunshot wound of many years' duration. Searching the literature on a detailed technique for complete repair of such a fistula proved fruitless. Hence, we were thrown upon our own resources. We planned this operation which proved safe and successful. Repair of a subclavian arteriovenous fistula is a challenging piece of surgery. The location of this fistula under the clavical and its proximity and connection to important structures in the neck and the thoracic outlet makes its correction difficult and hazardous. The purpose of this paper is to present this method of safe repair and discuss the pitfalls and safeguards.
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8/133. Carotid artery-sygmoid sinus fistula: a rare complication of gunshot wound on the base of the cranium.

    Vascular lesions without clinical manifestation may occur in cranial-facial wounds produced by bullets that course the base of the cranium. This work describes a rare kind of vascular complication in cranial-facial gunshot wound. The authors present the case of a patient, the victim of a cranium-maxillary gunshot wound. Carotid angiography revealed a carotid-sygmoid sinus fistula that filled the sygmoid and transverse sinuses, concomitant to the arterial angiographic phase. A direct communication between the external carotid artery and the sygmoid sinus was disclosed. We are not aware of any other description of this vascular complication in cranial gunshot wound. It is important to recognize this kind of complication in cases of cranial-facial gunshot wound, because new factors harmful to the brain perfusion systems are introduced, in addition to the alterations to venous return and intracranial pressure, caused by the primary trauma. The new non-invasive vascular diagnostic methods are proving useful in filling the gap left by arteriography, which is no longer used in these cases.
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9/133. diagnosis and management of trauma and iatrogenic induced arteriovenous fistulas in the neck.

    Trauma-induced arteriovenous (av) communications in the cervical region involving the external carotid artery and the jugular vein are exceptionally rare. Moreover, an iatrogenic av fistula between the vertebral artery and the vein after insertion of a venous catheter into the internal jugular vein is described. The discussion includes the clinical presentation, diagnosis and management of such rare av fistulas.
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10/133. Endovascular treatment of an aortic aneurysm ruptured into the inferior vena cava.

    PURPOSE: To report the endovascular repair of a rare abdominal aortic aneurysm (AAA) rupture into the inferior vena cava. methods AND RESULTS: A 74-year-old man with a 6.0-cm saccular aortic aneurysm and a previously undiagnosed aortocaval fistula of more than 2 weeks' duration was treated successfully with a Vanguard bifurcated stent-graft. The aneurysm was excluded and no endoleak or communication between the aorta and inferior vena cava was seen on computed tomographic imaging at the 6-month evaluation. CONCLUSIONS: Aortic endografting in this life-threatening complication is an effective treatment option that avoids the significant blood loss encountered in conventional repair.
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