Overview
Iatrogenic coronary artery fistulas are abnormal connections created between a coronary artery and another vascular structure, often resulting from medical interventions such as catheterization or surgical procedures. These fistulas can lead to hemodynamic disturbances and myocardial ischemia if left untreated 2.Diagnosis
Clinical Presentation: Often asymptomatic but may present with angina, dyspnea, or arrhythmias 2.
Imaging Studies: Echocardiography, coronary angiography, and CT angiography are crucial for diagnosis 2.
Grading: Not explicitly detailed in provided abstracts; typically graded based on hemodynamic significance and size 2.Management
First-Line Treatment: Transcatheter closure using devices like covered stents or flow diverters (e.g., Pipeline embolization device) 1.
Adjunctive Treatments: Ultrasound-guided compression for stable pseudoaneurysms (though more common in femoral artery injuries) 2.
Surgical Intervention: Reserved for complex cases or failures of endovascular approaches, particularly for arterial repair 2.Special Populations
Comorbidities: Management strategies may need adjustment in patients with significant comorbidities; specific guidance not detailed in provided abstracts 2.Key Recommendations
Endovascular Reconstruction: Use covered stents or flow diverter devices for closure of iatrogenic coronary artery fistulas (Evidence: Moderate) 1.
Selective Management: For femoral artery injuries, selectively manage with surgical repair for complex cases like pseudoaneurysms, hematomas, and arteriovenous fistulas (Evidence: Moderate) 2.
Monitor Hemodynamic Stability: Closely monitor patients for hemodynamic instability and adjust management based on imaging findings (Evidence: Expert opinion) 2.References
1 Ghorbani M, Griessenauer CJ, Shojaei H, Wipplinger C, Hejazian E. Endovascular reconstruction of iatrogenic internal carotid artery injury following endonasal surgery: a systematic review. Neurosurgical review 2021. link
2 Steinsapir ES, Coley BD, Fellmeth BD, Roberts AC, Hye RJ. Selective management of iatrogenic femoral artery injuries. The Journal of surgical research 1993. link