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 34-year-old male patient had been treated by HD in the last 3 years via left brachiocephalic AVF. He presented with gradually increasing painful swelling of the left upper limb, a sign of VH. He was evaluated with CT angiography and documented to have stenosis at IJV and left brachiocephalic vein. Under local anesthesia, the right common femoral artery access was secured with a 5 French sheath. Using 5 French H1 catheter and hydrophilic guide wire, left brachial artery angiogram was performed. The left common femoral venous access secured. However, H1 catheter could not be negotiated into left brachiocephalic vein (the angiogram also confirmed the presence of an occlusion in left brachiocephalic vein. Echelon – 10 and traxcess for guide wire was placed within the venous side of AVF. A 6 × 20 microplex 18 coil was placed in the venous side. Subsequently 5 × 15 (GDC – 18) and 4 × 10 (GDC – 10) coils were placed within the venous side of a fistula, followed by introduction of fibrin glue, 1 ml (1:2 dilution). Final check angiogram revealed closure of AVF. Right lower limb was immobilized for 6 h and left upper limb raised. Limb edema disappeared in 48 h [].