Wavelinq Endovascular Arteriovenous Fistula Creation For Treatment Of Complications Of Congenital Cardiovascular Disease
Clay P. Wiske, MD, MBA, Shawn Thomas, MD, Jason Wei, MD, Mikel Sadek, MD, Karan Garg, MD, Michael Barfield, MD, Glenn Jacobowitz, MD, Thomas Maldonado, MD, MA, Dan Halpern, MD, Todd Berland, MD.
NYU, New York, NY, USA.
DEMOGRAPHICS AND HISTORY: We report two cases in which endovascular arteriovenous fistulae were created to address the sequalae of congenital heart defects with multiple prior failed interventions. In case A, a 27 year-old woman with baseline oxygen saturation around 75%, a history of congenital tricuspid atresia, ventricular septal defect, a Blalock-Taussig shunt, and recurrent severe pulmonary vascular malformations underwent upper extremity AV fistula creation in order to increase hepatic factors in the pulmonary circulation, which has been shown to be beneficial in patients with severe pulmonary vascular malformations. In case B, a 14-year-old male with Trisomy 21 and an unbalanced AV canal defect found to have retrograde flow in the left pulmonary artery underwent upper extremity AV fistula creation to augment venous return to the left pulmonary artery.
PLAN: An endovascular approach to AV fistula creation with the WaveLinQ device provided access to the deep venous system and a shortened operative time for patients with severe comorbidities.
DISCUSSION: Endovascular arteriovenous fistula creation (endoAVF) has in recent years provided an alternative to traditional open dialysis access creation. In these cases, endoAVF was used to create a deliberate shunt in patients with severe congenital heart disease (Figure 1). Both patients had improvement in their baseline oxygen saturations within one month of the procedure. To our knowledge, this is the first time that endovascular AV fistula creation has been used to mitigate the long-term complications of congenital heart disease.
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