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Doctor's Information

Name : Hamidreza,Morteza
Family : Haghighatkhah,Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Mohsen Zakavati,Afarin Sadeghian

Case Section

Interventional Radiology

Patient's Information

Gender : Male
Age : 37

Clinical Summary

37-year-old man with prior history of orthopedic surgery presented with calf pain and feeling thrill in clinical examination along with angiographic confirmation of peroneal AVF

Imaging Findings

Right peroneal angiogram shows that distal third of peroneal artery leads to a single pouch that drains into the dilated peroneal vein associated with downstream venous backflow.At first,catheter placed at the arterial end of the fistulous pouch and 4-mm helix tornado coil was released,but immediately coil migrated proximally through the rapidly flowing fistula into the dilated draining vein and finally lodged in the ascending branch of left pulmonary artery.In second step,for reducing AVF flow,SFA compression and cuff-compression of the proximal calf venous flow were done.Catheter passed the fistula and tip of the catheter was placed in the downstream fistulous venous segment and looped in the fistulous pouch.After releasing of 8-mm helix coil,coil repositioned across the fistula.In the same way,second and third coils repositioned proximal to the initial coil while the tip of the catheter was placed in the arterial end of the fistulous pouch and then angiographic oblitration was obtained after 5 minutes.

Differential Diagnosis

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Final Diagnosis

Peroneal AVF coiling

Discussion (Related Text)

Coils can be grouped into microcoils and macrocoils. Macrocoils, also called Gianturco coils, were first introduced in 1975. Coils have the advantage of being precisely positioned under fluoroscopic control. Occlusion occurs as a result of coil-induced thrombosis rather than mechanical occlusion of the lumen by the coil. To increase the thrombogenic effect, Dacron wool tails are attached to coils. The coils are available in many sizes and may be delivered through commonly used angiographic catheters.Microcoils (platinum coils) can be delivered through microcatheters. They can be particularly useful when superselective coil embolization is required. Microcoils are highly thrombogenic, radiopaque, and biocompatible. Again, the thrombogenic effect primarily results from the addition of silk or synthetic fibers, not from the coil.Collateralization is a potential disadvantage of coil embolization, and it can result in the persistence of flow into the vascular territory of the vessel that was embolized with the coil. Additionally, when proximal occlusion occurs with coil embolization, repeat intervention via the same artery becomes difficult, if not impossible. Mechanically and electronically detachable coils are currently available.

References

AJNR 19:1565–1569, September 1998

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