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Coronary Artery Fistulas: Indications, Techniques, Outcomes, and Complications of Transcatheter Fistula Closure

https://doi.org/10.1016/j.jcin.2021.02.044Get rights and content
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Highlights

  • CAF can present with various anatomic configurations and clinical syndromes.

  • Closure can be effective treatment for carefully selected symptomatic CAF.

  • CAF closure procedures can be complicated by post-procedural MI.

  • Large registries are needed to understand the natural history of various CAF.

Abstract

Coronary artery fistulas (CAFs) are rare coronary anomalies that are usually diagnosed incidentally with cardiac imaging. Small CAFs are generally asymptomatic and can close over time, while some untreated medium or large CAFs can enlarge, leading to clinical sequelae such as cardiac chamber enlargement or myocardial ischemia. With the advancement of transcatheter equipment and techniques, CAFs have been increasingly closed using a percutaneous approach. However, the procedure is not free of limitations given the risk for myocardial infarction, device embolization, and fistula recanalization. In this review, the authors illustrate the contemporary procedural considerations, techniques, and outcomes of transcatheter CAF closure.

Key Words

chest
coronary artery fistula
percutaneous closure

Abbreviations and Acronyms

AV
arteriovenous
AVP
Amplatzer Vascular Plug
CAF
coronary artery fistula
CT
computed tomographic
MI
myocardial infarction
RCA
right coronary artery

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