Iatrogenic Femoral Arteriovenous Fistula with Pseudoaneurysm Associated with Worsening Heart Failure Years after Percutaneous Impella Placement.
Iatrogenic Femoral Arteriovenous Fistula with Pseudoaneurysm Associated with Worsening Heart Failure Years after Percutaneous Impella Placement.
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DOI：
10.1155/2022/7005236
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发表时间：
2022
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医源性动静脉瘘（AVF）和假性动脉瘤（PSA）是罕见的并发症，可能在建立血管通路数年后出现。据推测，大量血流通过这些动静脉瘘会导致慢性心力衰竭。文献中极少有关于在置入Impella装置后形成动静脉瘘或假性动脉瘤的描述。在此，我们介绍一位患者，三年前经右侧腹股沟经皮置入了Impella心室辅助装置，现出现心力衰竭加重及容量超负荷症状。检查发现其存在一处新的、高流量的股总动脉 - 股静脉动静脉瘘，并伴有一个假性动脉瘤。随后对该动静脉瘘及相关假性动脉瘤进行了切除和修复。本病例研究突出了经皮置入Impella装置后一种罕见的穿刺部位并发症与心力衰竭加重的关联，介绍了在进行外周血管穿刺时预防该并发症的策略，同时强调对于有外周血管穿刺史且出现不明原因心力衰竭加重的患者，有必要考虑这一鉴别诊断。
Iatrogenic arteriovenous fistulas (AVFs) and pseudoaneurysms (PSAs) are rare complications that may develop years after vascular access, and high-volume flow through these AVFs have been hypothesized to contribute to chronic heart failure. Formation of an AVF or PSA following Impella placement has rarely been described in the literature. Here, we describe a patient who had percutaneous placement of an Impella ventricular assist device through his right groin three years prior, now presenting with worsening heart failure and symptoms of volume overload. He was discovered to have a new, high-flow common femoral artery to femoral vein AVF with an associated PSA. The AVF and associated PSA were resected and repaired. This case study highlights a rare access-site complication from percutaneous Impella placement associated with worsening heart failure, strategies for preventing this complication during peripheral access, and the need to consider this differential in such a patient with a history of peripheral access who has an unexplained worsening of heart failure.