Iatrogenic Femoral Arteriovenous Fistula with Double Connection between Femoral Artery and Vein Leading to High-Output Heart Failure Years after Mitral and Tricuspid Valve Replacement

Arteriovenous fistulas (AVFs) are potentially harmful but curable complications of diagnostic and interventional cardiac catheterizations. In this report, we present a case of iatrogenic AVF both from superficial and deep femoral arteries to common femoral vein leading to progressively developing severe right-sided heart failure in a patient who had two normally functioning mechanical valves at mitral and tricuspid positions. A 58-year-old woman who had a history of mitral and tricuspid valve replacement operations was admitted to our clinic with exertional dyspnea, palpitation, abdominal tenderness, and right-sided inguinal pain. Coronary angiography was performed via right femoral arterial access ten months ago. Doppler ultrasonography and computerized tomography revealed right superficial femoral artery to common femoral vein fistulisation. The patient was operated, and a double connection between the femoral artery and vein was encountered and treated successfully. Soon after the surgical procedure, clinical signs of right-sided heart failure ceased dramatically. The postoperative course was uneventful. Access site complications following interventional procedures represent significant problems. Sudden and progressive clinical deterioration in a patient especially with a history of diagnostic or therapeutic cardiovascular intervention may evocate the possibility of peripheral access site AVF formation.