case_images: PMC10797860_01
case_images: PMC10797860_02
case_images: CT angiogprahy: (A) coronal section, (B) 3D reconstruction. Normal femoral artery (red arrow head), dilated femoral artery (red arrow) and aneurysmal dilatation of the iliac vein (white arrow head).
case_images: fsurg-10-1295595-g001.jpg
case_images: PMC10797860_02_fsurg-10-1295595-g001.jpg
case_images: F1
case_images: Subsequently, a CT angiography scan revealed severe dilation from the inferior vena cava to the right femoral vein and aneurysms in the dilated right common iliac artery, internal iliac artery, and external iliac arteries (Figures 1, 2).
case_images: CT angiogprahy: axial section, dilated common iliac artery (arrow head) and vein (arrow).
case_images: fsurg-10-1295595-g002.jpg
case_images: PMC10797860_02_fsurg-10-1295595-g002.jpg
case_images: F2
case_images: Subsequently, a CT angiography scan revealed severe dilation from the inferior vena cava to the right femoral vein and aneurysms in the dilated right common iliac artery, internal iliac artery, and external iliac arteries (Figures 1, 2).
case_images: (A) angiography shows enlargement of the femoral artery (red arrow head), and a fistula connecting (dashed box) the deep femoral artery and the femoral vein, leading to early enhancement and aneurysmal dilatation of the femoral vein (red arrow). (B) The catheter enters the femoral vein (white arrow head) through the fistula through the deep femoral artery.
case_images: fsurg-10-1295595-g003.jpg
case_images: PMC10797860_02_fsurg-10-1295595-g003.jpg
case_images: F3
case_images: Femoral AVF was confirmed on angiogram at the beginning of the deep femoral artery with an large aneurysm connecting with the common femoral vein (Figure 3).
case_images: (A) An interventricular septal occluder is positioned at the fistula between the deep femoral artery and femoral vein (white arrow head). After the placement of the occluder, angiography shows that the fistula was closed with only a small residual shunt.
case_images: fsurg-10-1295595-g004.jpg
case_images: PMC10797860_02_fsurg-10-1295595-g004.jpg
case_images: F4
case_images: A Lifetech delivery sheath was introduced over the wire from the femoral vein through the AVF to the femoral artery. Under fluoroscopic guidance, an 8 mm (3-5 mm larger than the size of the fistula) VSD occluder (Lifetech, HeartR, XJFVJ08) with its corresponding delivery cable was inserted through the sheath and the device was deployed in the AVF. Aortography was done again to confirm fistula closure, with a small residual shunt remaining (Figure 4).