Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.0024
Jornal Vascular Brasileiro
Therapeutic Challenge

Hybrid treatment of arteriovenous fistula between popliteal vessels

Tratamento híbrido para fístula arteriovenosa entre vasos poplíteos

Adenauer Marinho de Oliveira Góes Junior; Salim Abdon Haber Jeha; Reinaldo Sérgio Monteiro Franco

http://dx.doi.org/10.1590/1677-5449.0024 J Vasc Bras, vol.13, n4, p.325-329, 2014
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Abstract

The authors describe treatment of a patient who presented an arteriovenous fistula between the popliteal vessels more than 20 years after a gunshot wound. The patient underwent endovascular treatment using Viabahn (Gore®) stent grafts, but, because of the large disparity in popliteal artery diameters proximal and distal of the fistula, the endovascular treatment was unsuccessful. The superficial femoral artery was then banded around the stent graft that was deployed previously. This improvised strategy allowed an open surgical approach to be performed far from the fistula site, reducing the risks of operating in a region with anatomic distortions and significant enlargement of the surrounding venous structures, which would certainly have increased the likelihood of iatrogenic injuries.

Keywords

arteriovenous fistula, surgery, popliteal artery, popliteal vein, endovascular procedure, vascular system injuries

Resumo

Os autores descrevem o tratamento de um paciente portador de fístula arteriovenosa entre vasos poplíteos com mais de 20 anos de evolução, após ferimento por projétil de arma de fogo. O paciente foi submetido a tratamento endovascular pelo implante de stents revestidos Viabahn (Gore®), porém o mesmo não foi bem sucedido devido à diferença de diâmetro entre a artéria poplítea proximal e a distal à fístula. A artéria femoral superficial foi submetida à cerclagem com fios de sutura ao redor do stentgraft previamente implantado. Esse recurso de improvisação permitiu uma abordagem distante do sítio da fístula, diminuindo os riscos do acesso cirúrgico em uma região com distorções anatômicas e vasos sanguíneos ectasiados, o que certamente acarretaria maior risco de lesões iatrogênicas.

Palavras-chave

fístula arteriovenosa, cirurgia, artéria poplítea, veia poplítea, procedimento endovascular, lesões do sistema vascular

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