Staged Endovascular Treatment for Peripheral Arterial Disease with Arteriovenous Fistula and Venous Insufficiency

• Published in: Japanese Journal of Vascular Surgery Vol. 31; no. 6; pp. 375 - 378
• Main Authors: Yamanoha, Tatsushi, Suzuki, Kazuhiko, Ko, Yoshihiro, Hoshina, Toshiyuki, Shimizu, Shogo
• Format: Journal Article
• Language: Japanese
• Published: JAPANESE SOCIETY FOR VASCULAR SURGERY 23.12.2022; 特定非営利活動法人 日本血管外科学会
• Subjects: arteriovenous fistula; cyanoacrylate; endovascular treatment; peripheral arterial disease; venous insufficiency; シアノアクリレート; 下肢動静脈瘻; 末梢動脈疾患; 血管内治療; 静脈不全
• ISSN: 0918-6778; 1881-767X
• DOI: 10.11401/jsvs.22-00071

We performed staged endovascular treatment for a rare case with comorbid peripheral arterial disease, arteriovenous fistula, and venous insufficiency in the leg. A 79-year-old man presented with pain, bulging veins, and skin pigmentation in the left leg. Computed tomography revealed a long occlusion of the left femoral artery and arteriovenous fistulas between the peroneal artery and the great saphenous vein. Although the ankle brachial pressure index was normalized, the left leg symptoms and skin perfusion pressure did not improve after endovascular treatment for the femoral artery due to blood stealing to the great saphenous vein and venous insufficiency through micro arteriovenous fistulas. Therefore, we underwent full length closure of the great saphenous vein using cyanoacrylate closure (CAC) and coil embolization for the residual arteriovenous fistula. Subsequently, the patient’s symptoms rapidly disappeared and the circulation in the leg improved. Staged arteriovenous endovascular treatment may be effective in cases of complex vascular disease, as in this case. In particular, CAC may be a useful treatment for micro arteriovenous fistulas that mainly return to the saphenous vein.