• Vincent Vidal, Eric Therasse, Alexis Jacquier, Marie-France Giroux, Sébastien Bommart, Jean-Michel Bartoli, Vincent L Oliva, Frédérick Cohen, Jean-François Blair, Guy Moulin, Michel Philie, and Gilles Soulez.
• Department of Radiology, Hôpital Timone, Marseille, France.
• J Vasc Interv Radiol. 2006 Mar 1; 17 (3): 481-6.

PurposeTo evaluate the safety and efficacy of endovascular treatment of symptomatic arteriovenous (AV) fistulas associated with femoropopliteal in situ venous bypass grafts.Materials And MethodsTwenty-one patients underwent embolization of symptomatic AV fistulas associated with lower-limb bypass with use of the saphenous vein (n = 16) or femoral vein (n = 5). The procedures were performed with microcatheters and metallic coils. Indications for embolization were venous congestion (n = 15) and arterial insufficiency (n = 6). Eight patients had persistent lower-limb edema, seven had painful inflammatory skin thickening, three had intermittent claudication, and three had nonhealing ulcers.ResultsForty-four AV fistulas were embolized. Symptoms of venous congestion regressed completely in 12 of 15 patients (80%). Partial symptom improvement was achieved in three other patients (20%), two of whom had persistent lower-limb edema and bypass with use of the femoral vein. Five of six patients with ischemic symptoms (83%) had complete symptom relief. One patient (17%) whose ischemic ulcer did not recover despite successful embolization of AV fistulas required an amputation 4 months later. Overall, 17 of 21 patients (81%) showed complete recovery of clinical symptoms. There was no bypass occlusion during follow-up (mean, 17.5 months; range, 1-45 months).ConclusionsEmbolization of symptomatic AV fistulas secondary to lower-limb in situ venous bypass is a safe and efficient alternative to surgical ligature. Complete regression of clinical symptoms is less likely when the bypass is performed with use of the femoral vein.

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