A 49-year-old man underwent catheter ablation for drug-refractory atrial fibrillation using right femoral access. A 3-French sheath was placed in the right CFA, and an 8-French sheath was placed in the right FV during the catheterization. After the procedure, he developed swelling around the puncture site, and a bruit was audible in the right groin on auscultation. An AVF was detected by color Doppler ultrasound (Figure ). Ultrasound-guided compression was attempted but was unsuccessful. Enhanced computed tomography (CT) showed an MCFA originating from the CFA that crossed anterior to the FV and an arteriovenous communication (Figure ).\nExpecting spontaneous resolution, the patient was initially treated conservatively. After six months of follow-up, the AVF did not disappear on ultrasonography, and he suffered recurrence of atrial fibrillation. Considering the risk of future cardiac complications due to sustained volume overload, surgical intervention was performed. Surgical exploration revealed a dilated MCFA that crossed anterior to the FV (Figure ).\nThe MCFA was attached to the FV, and thrill was present. Ligation of the AVF was performed. A completion angiogram demonstrated successful closure of the AVF (Figure ).\nThe postoperative course was uneventful, and the patient was discharged on postoperative day 4.
A 63-year-old male patient had been treated by HD in the last 5 years via left brachiobasilic AVF. He presented with gradually increasing painful swelling of the left upper limb, a sign of VH. CT angiography documented left brachiobasilic vein stenosis with extensive collaterals in the upper limb. Under local anesthesia, the right common femoral artery access was obtained with 8 french arterial sheath. This was followed by 5 french micro venous sheaths in left basilic vein, distal to stenosis site via left common femoral venous access. Then a Swan-Ganz catheter was placed in the left brachial artery just proximal to fistula site, followed by inflation of the balloon, check angiogram showed patent fistula site with stenosis of basilic vein. Through dilator of 5 French sheath – 6, 8 cm × 5 cm pushable coils were placed in venous side just distal to fistula, followed by introduction of fibrin glue, 1 ml (1:2). Final check angiogram documented successful embolization. Also, in this case, a rapid disappearance of the edema occurred with a progressive resolution of the elephantiasis [].