195
Arteriovenous Fistulas After Median SternotomyReport of 2 cases and review of the literature R. Thi el, and W Bircks
Summary
Zus a m me nfassung
We re port 2 cases of arterioven ous fistulas as a ver y rare complication following median st ernotomy. In th e first case a fistu la was observ ed betw een th e right intern al mammary artery and vein caus ed by a sternal wire. The seco nd pa tient developed a fistula betw een th e innominate artery and left innominate vein afte r suture repair of a slight hemorrhage from th e innominate vein . The latter localization has not been pr evious ly described . In both cas es th e fistulas were disc overed by a continuous murmur app earing 12 and 11 da ys postoper ati vely. Th e therapy consisted of rest ernotomy and resection of the fistulas. Th e literatu re is reviewed and etiology, diagnosis and th erapy are discussed .
Wir berichten tiber 2 Faile a rte rioveniiser Fist eln als sehr seltene Komplikation nach medianer Sternotomie. Im einen Fall kam es ofTensi chtlich durch eine Lasion ein es Sternaldrahtes zu eine r Fistel zwis chen der rechten A. und V. thoracica interna . 1m anderen Fall entwickelte sich nach eine r Umste chung ein er Blutung im Ber eich der Querv en e eine arterioveniise Fiste l zwischen dem Truncus brachiocephalicus und der V. brachioc ephalis sinistra . Die zweite Lokalisation ist bisher nicht beschrieben worden . In beiden Fallen ma cht e sich die Fistel durch ein Maschinengerausch am 12. bzw. 11. postoperativen Ta g bem erkbar. Die Behandlung best and in der Rest ernotomie und Res ektion der Fisteln . Atiologie, Diagnos e und Th erapie werden im Zusammenhang mit der Literatur eriirte rt. Keywords Arteriovenous fistula - Intern al mammary artery - Innomi nate artery - Sternotomy
Median sternotomy is the most common app roach in cardiac surgery. It is fast to perform, reveals the best overview of the heart and the great vessels, and is easy to close with sternal wires. Severe complicatio ns occur in up to 8 per cent as sternal and mediastinal infection or sternal dehiscence (1 5). Arte riovenous (AV) fistulas following median sternotomy are rare. In the literature 4 cases of arteriovenous fistulas of the inte rnal mam mary vessels after open heart surgery are reported (1 , 4, 12, 14). We describe 2 further cases : an AV-fistula between the right intern al mammary artery (IMA) and vein, and an AV-fistula betw een the innominate artery an d left innominate vein . The latter localization has not been described before in the literature.
grade IIIYI high-frequen cy continuo us murmur at the right sternal bord er in the second and third intercostal spac e. An art eriovenous fistula was suggested and a retrograde selective angiography confirmed the diagnosis of an iatrogenic fistula of the internal mam mary vessels (Fig. 1).
Case 1
A 69-yea r old woma n with a history of streptococcal endoca rditis and rupture of the chordae tendineae of the anterior mitral valve leaflet res ulting in severe mitral insufficiency was adm itted for operation. She underwent a mitr al valve replacement with a 29-mm St.-Jude medical prosthesis without any complications intraop erative ly. There wer e, especially, no signs of a retrosternal bleeding . The median sternotomy was closed with six wires as usual. The early postoperative period was uneventful. On th e 12 th postoperativ e day physical examination revea led a
Thorac. cardiovasc. Surgn 38 (1990) 195-197 © Georg Thieme Verlag Stuttgart · New York
Fig. 1 Selective angiographyofthe right IMA showingthe AV·fistulabetween the right internal mammary arteryand vein at the levelof the thirdsternalwire
Received for Publication: January 8.1990
Downloaded by: Universite Laval. Copyrighted material.
Departm ent of Thoracic and Cardiovascular Surgery. Surgical Clinic and Policlinic. Heinrich-Heine-University of Dusseldorf, FRG
TllOrac_cardi(wasc. Surgn38 (1990)
R. Tluel. and lV. IJircks
A restern otomy was performed a nd a systolic whi zzling co uld be felt a t th e region of th e th ird rem oved wi re . The right int ernal ma mmary vessels were d issected . Iigat ed and resected. Insp ection uf the removed a nd open ed vessels showed a traumatic fistula between the IMA and vein. The pa tie nt mad e a n unevent ful recovery. Th e Nicoladon i-Bra nharn phenomen (decreased heart rate and increased blood pressure after resection of a fistula) was not observe d because of th e s ma ll s hunt-volum e.
Case 2 A :17-yea r old woman was admitted to ou r de pa rte me nt with the diagnosis of an a trial se pt al defect (ASD Ill. During routine median sternotomy and retraction of the sternum a slight hemorrhage was observed in the area of the left in nomina te vein. Th e bleeding was st oppe d by sut ure rep ai r of the injury. The ASD was closed usi ng a n autogenous pericardial patch. The postoperative course was uneventful and the m ur mur of th e ASD disa ppea re d . On the disch arge exa m ina tion on the 11th postope rati ve day a new systolic a nd diast olic machinery murmur was heard over the entire precordium bu t loudest ove r th e st erna l manub riu m. ECG. ec hoc a rdiogra ph. a nd ches t radiograph were normal. An a rte riove nous fistu la was sugges ted a nd a rethoracotom y was pe rformed . During the operation a systolic and diastolic vibration of the left innominate vein was found. The left innominate vein had to be divid ed be twee n cla m ps in orde r to m ak e th e junction between the innominate artery and vein visible. The fistula was resected and the innominate vein was reanast omosed . Th ereaft er the digita l examin a tio n a nd a usc ulta tion with a ste rile stetho scope sh owed neith er a whizzling nor a murmur and the patient has recovered well,
Iliscussion Postoperative substernal arteriovenous fistulas are rare in ca rdiac surge ry. We observ ed only 2 cas es in the past 30 years. Nevertheless iatrogenic injuries of thoracic vessels hap pen occa siona lly. Hines (9) for exa m ple describe s 2 cases of avulsion of the left innominate vein from the superior vena cava due to retraction of the sternum. Iatrogen ic AV-fistulas a re more frequent following ce nt ra l ven ous ca the te r insertion (3. 7. 8. 11. 16). It is worth mentioning th a t all re ported cases of AVfistulas of the internal mamm ary vessels including ou r case, co nce rn the right side (Table 1). In 4 of 5 ca ses the pati ents Table 1
were female. The fistulas occured twice after ao rto-coronary bypass grafting a nd three tim es aft er hea rt -va lve replacements. There is a correlation between the occurren ce of postop erative AV-fist ulas of the int ernal mamma ry vess els and the sternal closure. As we know from preparation of th e (MA for corona ry bypas s grafti ng there may be course variations of the internal mammary vessels, thus the y ma y be da ma ged by sternal wi res or sutures. In our case the fistula was in close proximity to a sternal wire. wh ich was pr ob ab ly the ca use of the fist ula (Fig. 1). The seco nd case was obse rved on the 11th day after a suture ligation of a hemorrhage of th e left innominate vein. Most of the rare case s of innominat e arteriovenous fistulas seem to be of traumatic origin (5). The leading symptom of an arteriovenous fistula is a continuous machinery murmur, audible in our patients 12 a nd 11 days post op eratively. Furth er sym ptoms may be a sho rtness of br ea th (1) or a co ntin uous buzzing vibra tion in th e ches t (12). Deuuaert et a l. (4) repor ted a subcuta neo us (!) pseudoa neurys ma l exte ns ion of a n AV-fistula of t he IM vessels, appearing as a subcutaneous tumor 3c m in diameter. The pati ent's loca l surgeon wa nt ed to re sec t this "lipoma", but fortun at ely th e patient refused . Th e dilTerentia l dia gnosis ofa n ew con tinuo us murmu r afte r med ia n ste rn oto my includes: ruptu re of sin us Valsa lva , pu lm onary AV-fistulas , an d th oraca l hem an giomas (2,10, 14). Arte riove nous fistulas of the internal ma mma ry vessels can also be of congenital or traumatic origin. S enno et al. (17) reviewed th e world literature a nd collected 1() congenital cas es, which were discovered between the first postp artal day a nd the 4 5 th yea r of life. Eight furthe r cases we re trauma tic a nd ma inly ca use d by gu nshot or stabwo un ds . Eve n a blunt che st traum a ca n result in a n AVfistu la of the in ternal mammary vessels (2, 10). Glenn et a l. (6) first described the iatroge nic origin of a n AV-fistula of th e IMA not following st ernot om y but a fter massive Iiga tion during a radical mastectomy. The indication for operation derives from the a ppre hen ded com plica tions like endo ca rditis lent a , rupture oflhe fistul a , a nd congestiv e hea rt failure (17). Th e he modynamic a nd structura l cha ng es of AV-fist ulas depend on th eir s ize a nd ta ke a lon g tim e to develop (5). Th ese com plicat ions s ho uld be av oide d by ea rly su rgica l the ra py. Th e tr eat men t of choice of ia trogen ic AV-fistu las a fte r median st e rn oto my consists of resternotomy and res ection or closure of the fistula. Ligation of the arterial and venous ves sel is des crib ed to be suffi cient (17), but co m plete resection should be preferred. Percutaneous vase-occlusio n can be
Reportedcasesof arteriovenousfistulas after median sternotomy incardiac surgery
Author
Year
Age. Sex
Diagnosis Operation Appearance of thefistula
Localization
Cause
Therapy
Longmaidet al.
74. F 55. F 62. M
AS
CAD
Deuvaertet al.
1980 1982 1987
sternal wire sternal wire stemal wire
rethorac.. resection rethorac.. tigation resection (aneurysma)
8entivegna et at.
1989
62. F
RIMA-RIMV RIMA-RIMV RIMA-RIMV + aneurysma RI MA-intercostal
sternal wire
vein catheterocclusion
stemal wire
rethorac.. resection rethorac.. resection
Maheret al.
MS
AVR ACBG MVR
2 months 1 month 3 weeks
CAD
ACBG
1 week
+ thymic vein
own case 1 own case2
69. F 37. F
MI
ASDII
MVR Closure
12 days 11 days
RIMA-RIMV innominate a.+v.
rettcrac.. ligation
vessel suture
Abbrev.: AS '" aorticstenosis. AVR '" aortic valve replacement, ACBG "" aorto coronarybypassgrafting, ASD "" atrial septal defect. CAD"" coronaryartery disease, MS "" mitral stenosis, Ml "" mitral insufficiency, MVR "" mitral valve replacement, RIMA "" rightinternal mammary artery, RIMV "" Right internalmammary vein
Downloaded by: Universite Laval. Copyrighted material.
19lJ
Thora e. eardiovasc. Surgfl 38 (l 990)
Arteriovenous Fistulas Aft er Median S ternotomy 10 II
12
Referen ces 13 I
2
3
4
5
(>
7
H
'I
Bentioeqna. P. E.. a nd C. B. lI umphrey : Arte riovenous fistula of inte rnal mammary artery afte r medi a n stern otomy. J. Ca rd iova sc. 5urg. 30 119891375-377 Boontje, A H.. a nd JI. JI. Kruyswijk: Arteriovenous fistul a of the interna l ma mmar y vessels. J . Thora c. Cardiovasc. Su rg . 62 (1971 ) 618-623 Christides. C.. M. Laskar. P. virot, F. DaTlY. P. Brutus. P. Blanc. a nd 1. 1. Doumetx. Les fistu les arterio-veneu ses mammai re s internes Iatroge ncs. Ann . Cardiol. Angcio l. 34 (985) 357-359 Ueuuaert. F. H.. N. Dumon t. G. Van Noote n. 1. De Paep e. and G. Prima: Poststernotomy arte rioveno us fist ula of in ternal mammary origin wit h pseu doan eurysmal subc utaneous exten sion . J. Card iovase . Surg. 28 (1987) 343 -345 Dos t. K. : Die trau matische arter tovenose Flstel. De r Chirurg 11 (19691506- 510 Glen". P. a nd I. S teinbera: Arteriove nou s fistu la of the righ t inte rnal mamma ry vessels follow ing ra d ical mastectomy: vis ua lization by a ng ioca rd iog rap hy . J. Th or acic Surg. 23 (1957) 719-722 fla nsbrough, J. F.. J. A Narrod. and R. Ru the rf ord: Arte r ioveno us fist ulas followi ng central venous catheterization . Intensive Care Med. 9( 1983 1287 -289 l kunoccd. H.. JI. Stoanton. a nd T. Treasure: Acqu ired a rte rioveno us comm unica tion: Complication of can nulation of in ternal jugu lar vein. British Med . J. 288 (1984) 1195 -1 196 llines. G. L.: Avulsion of the inno minate vein duri ng median ste r notom y. J. Cardlovasc. Surg. 22 (1981) 349 -3 52
14
IS
I II
17
Ish ik awa. T.. and G. R. Brown : Traumatic a rte rioven ou s fistul a of the internal ma mm ar y artery. J. Trau ma 17 (1977) 978- 980 Keiler. F. 5.. 1. Ros ch. R. L. Banner, a nd C. T. [Jotter: Iatrogenic internal mam ma ry artery to inn omina te vein fistula . Che st 8 1 11 9821255- 257 Lcnqmaid, H. E.. M. Jay. a nd D. Phi/lips: Angiog raphic eva luat ion of post-stern otomy a rte r iovenous fistula of th e internal ma mma ry artery and vein. Cardiovasc. Intervent. Hadiol. :3 (1980) 150- 152 Ma cl.ean. L. D.. a nd W. F. M az zilella: In nomina te a rte riovenous fistu la. A rep or t of o ne case and rev iew of the literature . J. Tho rac. and Cardiovasc. Surg . 39 (1969) 770 -77 6 Maher. T. D.. J. F. Gtenn. and 1. G. Maqooem: Intern a l mammary a rte r iovenous fistula afte r ste rnotomy. Arc h. Surg. 117 (1982) 1100-1 101 Scnfellipo. P. M.. a nd G. K. Dani elson: Comp licati ons associated with median ste rnotomy. J. Thorac. Ca rdiova sc. Surg. 63 (1972) 419- 423 Sat o. K.. Y. Tada. K. S udo. A Ueno. M. Nobori, a nd Y. Idezuki: Arterioven ou s fist ula follow ing central ven ous cat hete rization. Arch . Surg. 121 (1986) 729- 731 S enna. A. . P. S chuieizer. C. A. Merrill, an d R. Clauss: Arte riove nous fistulas of the internal mam mary artery . J. Cardiovasc. Surg . 16 (197 5) 296- 301
Pro! Dr. W Bircks Chirurgischc Khnik und Poliklinik Abte ilung fur Tho rax- und Kardiov as kularchiru rgte Hein n ch -Hein e- Univer sltat Dusseldcrf Moore ns traBe 5 D-400 0 Dusseldorf 1. FRG
Downloaded by: Universite Laval. Copyrighted material.
tried . if arteriography reveals the possibility (la) . The worldwide incre asing numb er of operative cardiac pro cedures probably will contribut e to an increase of this rare complication.
197
Arteriovenous Fistulas After Median SternotomyReport of 2 cases and review of the literature R. Thi el, and W Bircks
Summary
Zus a m me nfassung
We re port 2 cases of arterioven ous fistulas as a ver y rare complication following median st ernotomy. In th e first case a fistu la was observ ed betw een th e right intern al mammary artery and vein caus ed by a sternal wire. The seco nd pa tient developed a fistula betw een th e innominate artery and left innominate vein afte r suture repair of a slight hemorrhage from th e innominate vein . The latter localization has not been pr evious ly described . In both cas es th e fistulas were disc overed by a continuous murmur app earing 12 and 11 da ys postoper ati vely. Th e therapy consisted of rest ernotomy and resection of the fistulas. Th e literatu re is reviewed and etiology, diagnosis and th erapy are discussed .
Wir berichten tiber 2 Faile a rte rioveniiser Fist eln als sehr seltene Komplikation nach medianer Sternotomie. Im einen Fall kam es ofTensi chtlich durch eine Lasion ein es Sternaldrahtes zu eine r Fistel zwis chen der rechten A. und V. thoracica interna . 1m anderen Fall entwickelte sich nach eine r Umste chung ein er Blutung im Ber eich der Querv en e eine arterioveniise Fiste l zwischen dem Truncus brachiocephalicus und der V. brachioc ephalis sinistra . Die zweite Lokalisation ist bisher nicht beschrieben worden . In beiden Fallen ma cht e sich die Fistel durch ein Maschinengerausch am 12. bzw. 11. postoperativen Ta g bem erkbar. Die Behandlung best and in der Rest ernotomie und Res ektion der Fisteln . Atiologie, Diagnos e und Th erapie werden im Zusammenhang mit der Literatur eriirte rt. Keywords Arteriovenous fistula - Intern al mammary artery - Innomi nate artery - Sternotomy
Median sternotomy is the most common app roach in cardiac surgery. It is fast to perform, reveals the best overview of the heart and the great vessels, and is easy to close with sternal wires. Severe complicatio ns occur in up to 8 per cent as sternal and mediastinal infection or sternal dehiscence (1 5). Arte riovenous (AV) fistulas following median sternotomy are rare. In the literature 4 cases of arteriovenous fistulas of the inte rnal mam mary vessels after open heart surgery are reported (1 , 4, 12, 14). We describe 2 further cases : an AV-fistula between the right intern al mammary artery (IMA) and vein, and an AV-fistula betw een the innominate artery an d left innominate vein . The latter localization has not been described before in the literature.
grade IIIYI high-frequen cy continuo us murmur at the right sternal bord er in the second and third intercostal spac e. An art eriovenous fistula was suggested and a retrograde selective angiography confirmed the diagnosis of an iatrogenic fistula of the internal mam mary vessels (Fig. 1).
Case 1
A 69-yea r old woma n with a history of streptococcal endoca rditis and rupture of the chordae tendineae of the anterior mitral valve leaflet res ulting in severe mitral insufficiency was adm itted for operation. She underwent a mitr al valve replacement with a 29-mm St.-Jude medical prosthesis without any complications intraop erative ly. There wer e, especially, no signs of a retrosternal bleeding . The median sternotomy was closed with six wires as usual. The early postoperative period was uneventful. On th e 12 th postoperativ e day physical examination revea led a
Thorac. cardiovasc. Surgn 38 (1990) 195-197 © Georg Thieme Verlag Stuttgart · New York
Fig. 1 Selective angiographyofthe right IMA showingthe AV·fistulabetween the right internal mammary arteryand vein at the levelof the thirdsternalwire
Received for Publication: January 8.1990
Downloaded by: Universite Laval. Copyrighted material.
Departm ent of Thoracic and Cardiovascular Surgery. Surgical Clinic and Policlinic. Heinrich-Heine-University of Dusseldorf, FRG
TllOrac_cardi(wasc. Surgn38 (1990)
R. Tluel. and lV. IJircks
A restern otomy was performed a nd a systolic whi zzling co uld be felt a t th e region of th e th ird rem oved wi re . The right int ernal ma mmary vessels were d issected . Iigat ed and resected. Insp ection uf the removed a nd open ed vessels showed a traumatic fistula between the IMA and vein. The pa tie nt mad e a n unevent ful recovery. Th e Nicoladon i-Bra nharn phenomen (decreased heart rate and increased blood pressure after resection of a fistula) was not observe d because of th e s ma ll s hunt-volum e.
Case 2 A :17-yea r old woman was admitted to ou r de pa rte me nt with the diagnosis of an a trial se pt al defect (ASD Ill. During routine median sternotomy and retraction of the sternum a slight hemorrhage was observed in the area of the left in nomina te vein. Th e bleeding was st oppe d by sut ure rep ai r of the injury. The ASD was closed usi ng a n autogenous pericardial patch. The postoperative course was uneventful and the m ur mur of th e ASD disa ppea re d . On the disch arge exa m ina tion on the 11th postope rati ve day a new systolic a nd diast olic machinery murmur was heard over the entire precordium bu t loudest ove r th e st erna l manub riu m. ECG. ec hoc a rdiogra ph. a nd ches t radiograph were normal. An a rte riove nous fistu la was sugges ted a nd a rethoracotom y was pe rformed . During the operation a systolic and diastolic vibration of the left innominate vein was found. The left innominate vein had to be divid ed be twee n cla m ps in orde r to m ak e th e junction between the innominate artery and vein visible. The fistula was resected and the innominate vein was reanast omosed . Th ereaft er the digita l examin a tio n a nd a usc ulta tion with a ste rile stetho scope sh owed neith er a whizzling nor a murmur and the patient has recovered well,
Iliscussion Postoperative substernal arteriovenous fistulas are rare in ca rdiac surge ry. We observ ed only 2 cas es in the past 30 years. Nevertheless iatrogenic injuries of thoracic vessels hap pen occa siona lly. Hines (9) for exa m ple describe s 2 cases of avulsion of the left innominate vein from the superior vena cava due to retraction of the sternum. Iatrogen ic AV-fistulas a re more frequent following ce nt ra l ven ous ca the te r insertion (3. 7. 8. 11. 16). It is worth mentioning th a t all re ported cases of AVfistulas of the internal mamm ary vessels including ou r case, co nce rn the right side (Table 1). In 4 of 5 ca ses the pati ents Table 1
were female. The fistulas occured twice after ao rto-coronary bypass grafting a nd three tim es aft er hea rt -va lve replacements. There is a correlation between the occurren ce of postop erative AV-fist ulas of the int ernal mamma ry vess els and the sternal closure. As we know from preparation of th e (MA for corona ry bypas s grafti ng there may be course variations of the internal mammary vessels, thus the y ma y be da ma ged by sternal wi res or sutures. In our case the fistula was in close proximity to a sternal wire. wh ich was pr ob ab ly the ca use of the fist ula (Fig. 1). The seco nd case was obse rved on the 11th day after a suture ligation of a hemorrhage of th e left innominate vein. Most of the rare case s of innominat e arteriovenous fistulas seem to be of traumatic origin (5). The leading symptom of an arteriovenous fistula is a continuous machinery murmur, audible in our patients 12 a nd 11 days post op eratively. Furth er sym ptoms may be a sho rtness of br ea th (1) or a co ntin uous buzzing vibra tion in th e ches t (12). Deuuaert et a l. (4) repor ted a subcuta neo us (!) pseudoa neurys ma l exte ns ion of a n AV-fistula of t he IM vessels, appearing as a subcutaneous tumor 3c m in diameter. The pati ent's loca l surgeon wa nt ed to re sec t this "lipoma", but fortun at ely th e patient refused . Th e dilTerentia l dia gnosis ofa n ew con tinuo us murmu r afte r med ia n ste rn oto my includes: ruptu re of sin us Valsa lva , pu lm onary AV-fistulas , an d th oraca l hem an giomas (2,10, 14). Arte riove nous fistulas of the internal ma mma ry vessels can also be of congenital or traumatic origin. S enno et al. (17) reviewed th e world literature a nd collected 1() congenital cas es, which were discovered between the first postp artal day a nd the 4 5 th yea r of life. Eight furthe r cases we re trauma tic a nd ma inly ca use d by gu nshot or stabwo un ds . Eve n a blunt che st traum a ca n result in a n AVfistu la of the in ternal mammary vessels (2, 10). Glenn et a l. (6) first described the iatroge nic origin of a n AV-fistula of th e IMA not following st ernot om y but a fter massive Iiga tion during a radical mastectomy. The indication for operation derives from the a ppre hen ded com plica tions like endo ca rditis lent a , rupture oflhe fistul a , a nd congestiv e hea rt failure (17). Th e he modynamic a nd structura l cha ng es of AV-fist ulas depend on th eir s ize a nd ta ke a lon g tim e to develop (5). Th ese com plicat ions s ho uld be av oide d by ea rly su rgica l the ra py. Th e tr eat men t of choice of ia trogen ic AV-fistu las a fte r median st e rn oto my consists of resternotomy and res ection or closure of the fistula. Ligation of the arterial and venous ves sel is des crib ed to be suffi cient (17), but co m plete resection should be preferred. Percutaneous vase-occlusio n can be
Reportedcasesof arteriovenousfistulas after median sternotomy incardiac surgery
Author
Year
Age. Sex
Diagnosis Operation Appearance of thefistula
Localization
Cause
Therapy
Longmaidet al.
74. F 55. F 62. M
AS
CAD
Deuvaertet al.
1980 1982 1987
sternal wire sternal wire stemal wire
rethorac.. resection rethorac.. tigation resection (aneurysma)
8entivegna et at.
1989
62. F
RIMA-RIMV RIMA-RIMV RIMA-RIMV + aneurysma RI MA-intercostal
sternal wire
vein catheterocclusion
stemal wire
rethorac.. resection rethorac.. resection
Maheret al.
MS
AVR ACBG MVR
2 months 1 month 3 weeks
CAD
ACBG
1 week
+ thymic vein
own case 1 own case2
69. F 37. F
MI
ASDII
MVR Closure
12 days 11 days
RIMA-RIMV innominate a.+v.
rettcrac.. ligation
vessel suture
Abbrev.: AS '" aorticstenosis. AVR '" aortic valve replacement, ACBG "" aorto coronarybypassgrafting, ASD "" atrial septal defect. CAD"" coronaryartery disease, MS "" mitral stenosis, Ml "" mitral insufficiency, MVR "" mitral valve replacement, RIMA "" rightinternal mammary artery, RIMV "" Right internalmammary vein
Downloaded by: Universite Laval. Copyrighted material.
19lJ
Thora e. eardiovasc. Surgfl 38 (l 990)
Arteriovenous Fistulas Aft er Median S ternotomy 10 II
12
Referen ces 13 I
2
3
4
5
(>
7
H
'I
Bentioeqna. P. E.. a nd C. B. lI umphrey : Arte riovenous fistula of inte rnal mammary artery afte r medi a n stern otomy. J. Ca rd iova sc. 5urg. 30 119891375-377 Boontje, A H.. a nd JI. JI. Kruyswijk: Arteriovenous fistul a of the interna l ma mmar y vessels. J . Thora c. Cardiovasc. Su rg . 62 (1971 ) 618-623 Christides. C.. M. Laskar. P. virot, F. DaTlY. P. Brutus. P. Blanc. a nd 1. 1. Doumetx. Les fistu les arterio-veneu ses mammai re s internes Iatroge ncs. Ann . Cardiol. Angcio l. 34 (985) 357-359 Ueuuaert. F. H.. N. Dumon t. G. Van Noote n. 1. De Paep e. and G. Prima: Poststernotomy arte rioveno us fist ula of in ternal mammary origin wit h pseu doan eurysmal subc utaneous exten sion . J. Card iovase . Surg. 28 (1987) 343 -345 Dos t. K. : Die trau matische arter tovenose Flstel. De r Chirurg 11 (19691506- 510 Glen". P. a nd I. S teinbera: Arteriove nou s fistu la of the righ t inte rnal mamma ry vessels follow ing ra d ical mastectomy: vis ua lization by a ng ioca rd iog rap hy . J. Th or acic Surg. 23 (1957) 719-722 fla nsbrough, J. F.. J. A Narrod. and R. Ru the rf ord: Arte r ioveno us fist ulas followi ng central venous catheterization . Intensive Care Med. 9( 1983 1287 -289 l kunoccd. H.. JI. Stoanton. a nd T. Treasure: Acqu ired a rte rioveno us comm unica tion: Complication of can nulation of in ternal jugu lar vein. British Med . J. 288 (1984) 1195 -1 196 llines. G. L.: Avulsion of the inno minate vein duri ng median ste r notom y. J. Cardlovasc. Surg. 22 (1981) 349 -3 52
14
IS
I II
17
Ish ik awa. T.. and G. R. Brown : Traumatic a rte rioven ou s fistul a of the internal ma mm ar y artery. J. Trau ma 17 (1977) 978- 980 Keiler. F. 5.. 1. Ros ch. R. L. Banner, a nd C. T. [Jotter: Iatrogenic internal mam ma ry artery to inn omina te vein fistula . Che st 8 1 11 9821255- 257 Lcnqmaid, H. E.. M. Jay. a nd D. Phi/lips: Angiog raphic eva luat ion of post-stern otomy a rte r iovenous fistula of th e internal ma mma ry artery and vein. Cardiovasc. Intervent. Hadiol. :3 (1980) 150- 152 Ma cl.ean. L. D.. a nd W. F. M az zilella: In nomina te a rte riovenous fistu la. A rep or t of o ne case and rev iew of the literature . J. Tho rac. and Cardiovasc. Surg . 39 (1969) 770 -77 6 Maher. T. D.. J. F. Gtenn. and 1. G. Maqooem: Intern a l mammary a rte r iovenous fistula afte r ste rnotomy. Arc h. Surg. 117 (1982) 1100-1 101 Scnfellipo. P. M.. a nd G. K. Dani elson: Comp licati ons associated with median ste rnotomy. J. Thorac. Ca rdiova sc. Surg. 63 (1972) 419- 423 Sat o. K.. Y. Tada. K. S udo. A Ueno. M. Nobori, a nd Y. Idezuki: Arterioven ou s fist ula follow ing central ven ous cat hete rization. Arch . Surg. 121 (1986) 729- 731 S enna. A. . P. S chuieizer. C. A. Merrill, an d R. Clauss: Arte riove nous fistulas of the internal mam mary artery . J. Cardiovasc. Surg . 16 (197 5) 296- 301
Pro! Dr. W Bircks Chirurgischc Khnik und Poliklinik Abte ilung fur Tho rax- und Kardiov as kularchiru rgte Hein n ch -Hein e- Univer sltat Dusseldcrf Moore ns traBe 5 D-400 0 Dusseldorf 1. FRG
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tried . if arteriography reveals the possibility (la) . The worldwide incre asing numb er of operative cardiac pro cedures probably will contribut e to an increase of this rare complication.
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