Inadvertent aortocoronary arteriovenous fistula after CABG: Systematic review of case reports.

OBJECTIVE: To summarize published case reports of aortocoronary arteriovenous fistula (ACAVF) after coronary artery bypass grafting surgery (CABG). BACKGROUND: Inadvertent ACAVF is a rare complication following CABG. However, the incidence continues to rise, and its management details and clinical outcomes have not been well described. METHODS: To identify all published cases of ACAVF following CABG, PubMed, EMBASE, and Scopus were searched through November 2019. We defined ACAVF as inadvertent attachment of the grafting vessel onto a cardiac vein instead of targeted coronary artery. A systematic review was performed to identify the incidence, clinical features, and management outcomes. RESULTS: A total of 48 post-CABG ACAVF cases were gathered. Among these patients, the mean age was 61.9 years and 79.2% were men. Most common presenting symptoms were chest pain (60.4%) and dyspnea (27.1%). The average onset of symptoms was 3 years; however, 54.2% of patients developed symptoms within the first year. The majority of cases reported targeted native vessel LAD during CABG (62.5%). Of these cases, 9 (18.8%) were managed conservatively, 8 (16.7%) chose to undergo surgery including ligation of fistula and repeat CABG, and 27 (56.3%) underwent percutaneous closure. Among these patients 13 cases (27.1%) were managed with coil embolization, 5 (10.4%) with balloon embolization, 5 (10.4%) were treated with a covered stent, and 4 (8.3%) used a vascular plug. There were no reported complications following treatment in this group. CONCLUSIONS: Inadvertent ACAVF are rare following CABG. Percutaneous closure was feasible and safe in treating these patients.