CORONARY ARTERIOVENOUS-FISTULAS - COLLECTIVE REVIEW AND MANAGEMENT OF6 NEW CASES - CHANGING ETIOLOGY, PRESENTATION, AND TREATMENT STRATEGY

We considered it worthwhile to review the literature of the last decad e (1985-1995) to answer the question whether the etiology and the clin ical picture of coronary arteriovenous fistulas (CAVFs) have changed. Furthermore, new therapeutic modalities such as percutaneous transcath eter embolization have been developed, We tried to define the place of these techniques in the therapeutic arena. Clinical presentation and management of six patients with eight congenital CAVFs and 76 subjects with 96 congenital and acquired CAVFs taken from a review of the rece nt literature are presented. Sixty-three review subjects (78%) were tr eated medically, with one fatal case. Ligation of the fistula was achi eved by surgical techniques in 10% of review subjects, while percutane ous transcatheter embolization (PTE) was performed in nine patients (1 2%). Percutaneous transcatheter embolization techniques are being incr easingly used in the treatment of CAVFs, The etiology of CAVFs has a t endency to show alterations toward the acquired pathogenesis. In 64% o f the review subjects the fistula was congenital in origin, and in 36% it had an acquired cause, Among the patients of the current review, t he clinical presentations were 55% asymptomatic, 34% chest pain (angin al or atypical), and 13% congestive heart failure, The CAVFs of our si x patients are all congenital in origin. In the current review, the cl inical presentation showed a trend toward increasing chest complaints (34%) compared with the review (10%) published in the mid 1970s, This may be due to a higher mean age, and hence increased concurrent corona ry artery disease due to aging compared with the review population of two decades ago.