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PubMed2002

Congenital bronchoesophageal fistula and tracheoesophageal fistula with esophageal atresia.

A case of initial esophageal atresia and tracheoesophageal fistula in a female newborn, later complicated by pneumonia and a second bronchoesophageal fistula, is reported. She was treated surgically by closure of the tracheoesophageal fistula and by end-to-end esophago-esophageal anastomosis. An esophagram at 1 month of age was normal. Three months later she developed severe, persistent right lower lobe pneumonia that required intensive antibiotic therapy and respiratory support. Esophagography was repeated and revealed a second fistula between the right main-stem bronchus and the lower esophagus. The bronchoesophageal fistula was repaired, and a right lower lobectomy was performed. Postoperative recovery was uncomplicated. Histologic examination indicated that the fistula was congenital in origin. To the best of our knowledge, this is the first reported case of a congenital bronchoesophageal fistula coexisting with a tracheoesophageal fistula and esophageal atresia.

Abnormalities, Multiple↗
PubMed1991

Use of the fistula assessment monitor to detect stenoses in access fistulae.

Twenty-three unselected hemodialysis patients with functioning access arteriovenous fistulae were studied prospectively to determine the best technique for detecting stenoses within the fistulae. Combined clinical assessment and fistula assessment monitoring were compared with transbrachial angiography. Fistula assessment monitoring was more accurate (96%) than combined clinical assessment (accuracy, 52%) in stenosis detection. Complications of angiography occurred in 17% of patients; there were no complications of fistula assessment monitoring. Fistula assessment monitoring was better than combined clinical assessment in predicting clinical outcome for arteriovenous fistulae over 6 months and was as good as angiography. Routine fistula assessment monitoring could reduce inappropriate angiography and detect clinically significant silent stenoses. It is an ideal method for monitoring arteriovenous access fistulae.

Angiography↗
PubMed2001

Vascular access survival and incidence of revisions: a comparison of prosthetic grafts, simple autogenous fistulas, and venous transposition fistulas from the United States Renal Data System Dialysis Morbidity and Mortality Study.

OBJECTIVE: The study's aim was to evaluate access patency and incidence of revisions in patients initiating hemodialysis and to determine differences in access performance by type of access among patient subgroups. METHODS: The study used data from the United States Renal Data System Dialysis Morbidity and Mortality Study Wave 2, which contained a random sample of dialysis patients initiating dialysis in 1996 and early 1997. Failures and revisions were evaluated among 2247 newly placed hemodialysis accesses by using Cox proportional hazards regression model and Poisson regression. Primary and secondary patency rates were estimated using the Kaplan-Meier method. RESULTS: Fifteen hundred seventy-four prosthetic grafts, 492 simple autogenous fistulas, and 181 venous transposition fistulas were available for evaluation. Prosthetic grafts had a 41% greater risk of primary failure compared with simple fistulas (relative risk, 1.41; 95% CI, 1.22-1.64; P < .001) and a 91% higher incidence of revision (relative risk, 1.91; 95% CI, 1.60-2.28; P <.001). At 2 years, autogenous fistulas demonstrated superior primary patency (39.8% versus 24.6%, P < .001) and equivalent secondary patency (64.3% versus 59.5%, P = .24) compared with prosthetic grafts. When compared with simple fistulas, vein transpositions demonstrated equivalent secondary patency at 2 years (61.5% versus 64.3%, P = .43) but inferior primary patency (27.7% versus 39.8%, P = .008) and had a 32% increased incidence of revision (P = .04). Autogenous fistulas had superior primary patency compared with prosthetic grafts in all patient subgroups except for patients with previously failed access. Vein transpositions showed the greatest benefit in terms of patency and incidence of revision in women and in patients with previously failed access. CONCLUSIONS: The preferential placement of autogenous fistulas may increase primary patency and decrease the incidence of revisions. Vein transpositions had similar secondary patency compared with simple fistulas, but required more revisions. The greatest benefit of a vein transposition fistula was seen in women and in patients with a history of access failure.

Adult↗
PubMed1999

[Dural arteriovenous fistula of the transverse sigmoid sinus after transvenous embolization of the carotid cavernous fistula].

We report a case of dural arteriovenous fistula of the transverse-sigmoid sinus after transvenous embolization of the carotid cavernous fistula. A 72-year-old woman presented with left exophthalmos, chemosis, bruit and left abducens nerve palsy in June 1996. Bilateral external and internal carotid angiograms revealed the dural arteriovenous fistula of the cavernous sinus. We embolized the dural arteriovenous fistula using a transvenous approach via the left inferior petrosal sinus. Angiograms demonstrated the complete disappearance of the dural arteriovenous fistula. Two years and six months later, she complained of tinnitus at the retroauricular region. Left external carotid angiograms showed a dural arteriovenous fistula of the transverse-sigmoid sinus fed by occipital, posterior auricular, middle meningeal and superficial temporal arteries. We embolized the dural arteriovenous fistula using a transarterial approach. Her symptoms disappeared but the dural arteriovenous fistula did not disappear completely. We discussed the clinical features and etiology of this case.

Aged↗
PubMed1989

Bronchocutaneous fistula in dogs: influence of fistula size and ventilatory mode on airleak.

Bronchocutaneous fistula (BCF) can originate at different levels, from the major airways to the peripheral lung. Little is published on the influence of the fistula origin or the ventilatory effect of the airleak. This study evaluates relative CO2 elimination via fistulas of various size and how different ventilatory modes influence both the quantity and quality, i.e., oxygen and CO2 content, of the airleak. We created BCF with five polyethylene tubings of different diameters (tube 1, 3.0 mm; tube 2, 4.0 mm; tube 3, 5.1 mm; tube 4, 6.4 mm; tube 5, 9.8 mm) in nine dogs. Six modes of ventilation were used with each tubing: spontaneous breathing (SB), pressure support (PS), high frequency (HF), assisted controlled with inspiration set at 20% (AC20) and at 67% (AC67) of the respiratory cycle, and AC20 with an end-expiratory pressure of +10 cm H2O (PEEP). For each ventilatory mode, the fistula air flow (Vf), CO2, and oxygen partial pressure of fistula air (PfCO2 and PfO2) and arterial blood were measured. Vf was measured for all tubes, while gas analysis was done for tubes 1, 3, and 5 only. As expected, Vf increased with tubing size. Vf was higher with AC67 and PEEP than with the other ventilatory modes. PfCO2 was not significantly influenced by the tube size and Vf. Fistula air alveolization was increased only with HF ventilation. Air leaked via the fistula contributed significantly to gas exchange; even when expiration was totally via the fistula, the arterial gases remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2005

Dutch survey of congenital coronary artery fistulas in adults: coronary artery-left ventricular multiple micro-fistulas multi-center observational survey in the Netherlands.

BACKGROUND: Congenital coronary artery-left ventricular multiple micro-fistulas (CA-LVMMFs) in adults are rare anomalies. They may cause angina pectoris and myocardial infarction in association with normal coronary arteries. METHODS AND RESULTS: From the medical databases of a Dutch Survey of coronary artery fistulas in adult cardiology population (30,829 patients), we identified 20 patients with CA-LVMMFs out of 71 fistula-subjects between 1996 and 2003. Clinical files and individual coronary angiograms were reviewed and analysed. There were 13 females and 7 males with a mean age of 67.3 years (range 49-82). The main presenting symptoms were angina pectoris and dyspnea in 70% of the patients. The ECG showed pathologic changes in 75%. Exercise tolerance test and 201-thallium stress scintigraphy were positive for myocardial ischemia in 29% and 50%, respectively of the tested patients. In the absence of significant atherosclerotic coronary artery disease, ipsilateral to the fistulas, myocardial infarction was documented in 15% of the patients. Chest X-ray revealed cardiomegaly in 38% of the patients. Congestive heart failure was documented in 10% of the patients. Uni-, bi- and multilateral fistulas were present in 50%, 45% and 5%, respectively. The origin was the LCA in 71% and the RCA in 29% of the fistulas. The majority (97%) originated from the mid or distal segments of the coronary vessels. Among those patients, the coronary arterial tree had single, dual, and triple vessel disease in 25%, 15% and 5%, respectively. Angiographic anatomy precludes surgical intervention; they were all followed by conservative medical management. CONCLUSIONS: Coronary artery-left ventricular multiple micro-fistulas are found more often in female patients. Furthermore, they originated from the distal segment of the coronary arteries. Coronary artery-left ventricular multiple micro-fistulas, in the presence of normal coronary arterial tree, may often lead to angina pectoris and coronary insufficiency.

Adult↗
PubMedDate not supplied

Preservation of the fistula for reconstruction of the anal canal and the anus in atresia ani and rectovestibular fistula in 2 dogs.

OBJECTIVE: To report a technique for correction of atresia ani and rectovestibular fistula with fistula preservation, and outcome in 2 dogs. STUDY DESIGN: Case report. ANIMALS: Two intact female puppies. METHODS: The fistula was approached by episiotomy. A vertical median perineal incision was made starting dorsal to the anal region and extended to surround the fistula. The rectum and vagina were separated, and the end of the fistula was sutured to the skin. RESULTS: Early postoperative complications included constipation, fecal incontinence, and perineal soiling, but long-term outcome was good in both dogs. CONCLUSION: With careful dissection, the fistula and internal anal sphincter can be preserved and used in the surgical reconstruction of the anal canal and anus. CLINICAL RELEVANCE: Preservation of the fistula may provide an internal sphincter that contributes to a better functional result during correction of atresia ani. A surgical approach that combines episiotomy and perineal incision for separation of the vagina and rectum, and preserves the fistula may decrease the risk of dehiscence.

Animals↗
PubMed1995

Oral-maxillary sinus fistula (oroantral fistula): clinical features and findings on multiplanar CT.

OBJECTIVE: Oroantral fistula, an abnormal communication between the oral cavity and the maxillary sinus, is infrequently diagnosed radiologically. The purpose of this study was to describe the CT findings and clinical features of oroantral fistula and to show that dental CT multiplanar reformatting programs can be instrumental in diagnosing this condition. SUBJECTS AND METHODS: The study included eight patients with clinically confirmed oroantral fistula or with radiologic evidence of oroantral fistula. Fistula size, degree of alveolar atrophy, nature of maxillary sinus disease, and related dental disease were assessed along with the clinical presentations. RESULTS: The most frequent CT findings were bony discontinuity of the maxillary sinus floor, communication between the oral cavity and the sinus, soft-tissue opacification of the ipsilateral maxillary sinus, focal areas of alveolar atrophy, and associated periodontal disease. In 6 of 8 patients there was 100% opacification of the ipsilateral maxillary sinus, and in 5 of 8 patients the contralateral sinus appeared completely normal. The fistula size ranged from 13.5 mm2 to 189 mm2. CONCLUSION: The appearance of oroantral fistula on multiplanar CT imaging is disruption of the bony floor of the maxillary sinus with soft-tissue opacification of the ipsilateral sinus. Dental reformatted CT can be useful for evaluating patients suspected of having oroantral fistula, and this condition may be found incidentally in patients referred for evaluation for osseointegrated root-form dental implants.

Adult↗
PubMed1992

[Recurrent esophago-respiratory tract fistula after repair of esophageal atresia with tracheo-esophageal fistula].

Esophageal atresia is a congenital malformation present in 1 in 4500 live births. 85% of such newborns also have a fistula connecting the distal esophagus with the trachea. Operative management includes closing the fistula by disconnecting the distal esophagus from the trachea and performing end-to-end esophago-esophageal anastomosis. A late complication is a recurrence of the fistula between esophagus and respiratory tract. The recurrent fistula is usually between the esophagus and the trachea, but it may involve the bronchi or lung tissue. This complication causes significant respiratory morbidity, mainly recurrent pneumonia, and sometimes death. The diagnosis of recurrent fistula is usually by barium swallow and/or esphagobronchoscopy. Repair is a surgical challenge. We report 5 infants with recurrent esophago-respiratory tract fistulas out of a total of 68 cases of esophageal atresia with tracheo-bronchial fistula.

Abnormalities, Multiple↗
PubMed1997

Obstetric fistulae: a retrospective study of 1210 cases at the Addis Ababa Fistula Hospital.

The results of surgery in new patients presenting with a vesico-vaginal fistula are presented to relate the outcome to age, parity and aetiology of the fistula. Of the 1435 patients admitted to the hospital from January 1991 to December 1992, 1210 had had no previous attempt to repair the fistula and are included in the study. The data were collected from the patients records and a specially designed admission and treatment form. Of the 1210 cases analysed, the fistula was caused by obstructed labour in 96% (1160), and in the majority of these, labour was obstructed for more than 3 days. Half of the patients (598) were aged between 13 and 20 years on admission to hospital. Fifty-five per cent (649) developed a fistula during their first delivery and in 93% the fetal outcome was a still-birth. Of the operated 1210 cases, 1120 (92.6%) were successfully repaired. Five hundred and thirty patients were divorced by their husbands following development of the fistula. Illiteracy as common among the patients. Improvements in maternity services, development of communication networks and eradication of illiteracy are essential for the prevention of obstetric fistula. The role of reconstructive vaginal fistula surgery and the further training in this field is also emphasised.

Journal Article↗
PubMed2006

Spinal dural arteriovenous fistula associated with a spinal perimedullary fistula: case report.

Among spinal cord vascular malformations, dural arteriovenous fistulas (DAVFs) must be distinguished from intradural malformations. The concurrence of both is extremely rare. The authors report the case of a 35-year-old man who suffered from progressive myelopathy and who harbored both a DAVF and an intradural perimedullary fistula. During surgery, both fistulas were identified, confirmed, and subsequently obliterated. The fistulas were located at two levels directly adjacent to each other. Although the incidence of concurrent spinal DAVFs is presumed to be approximately 2%, the combination of a dural and an intradural fistula is exceedingly rare; only two other cases have been reported in the literature. One can speculate whether the alteration in venous drainage caused by the (presumably congenital) perimedullary fistula could possibly promote the production of a second dural fistula due to elevated pressure with concomitant venous stagnation and subsequent thrombosis. The authors conclude that despite the rarity of dual pathological entities, the clinician should be aware of the possibility of the concurrence of more than one spinal fistula in the same patient.

Adult↗
PubMed2006

The "Fistula VAC," a technique for management of enterocutaneous fistulae arising within the open abdomen: report of 5 cases.

BACKGROUND: Management of intestinal fistulae in open abdominal wounds remains a significant clinical challenge for those caring for patients surviving damage control abdominal operations. Breaking the cycle of tissue inflammation, infection, and sepsis, resulting from leakage of enteric contents, should be a major goal in the approach to these complex patients. We describe a technique utilizing vacuum assisted closure (VAC) which achieves control of enteric flow from fistulae in open abdominal wounds. METHODS: The fistula-VAC is fashioned from standard sponge supplies, negative pressure pumps, and ostomy appliances. The fistula-VAC was changed every three days prior to split thickness skin grafting, and every five days following grafting. RESULTS: Five patients underwent application of the fistula-VAC. All patients had complete diversion of enteric contents. This enteric diversion allowed for successful skin grafting in all patients. CONCLUSION: Application of the fistula-VAC should be considered a useful option in treating patients with intestinal fistulae in open abdominal wounds.

Colostomy↗
PubMed1978

Arteriovenous fistulas for long-term dialysis. Factors that influence fistula survival.

We reviewed our total experience with arteriovenous (AV) fistulas for long-term hemodialysis. We are unable to show any significant difference in the survival of AV fistulas based either on the type of material used to create the fistulas or on their location. Complications encountered early in this experience largely were due to technical or judgmental errors. Thrombosis of radiocephalic fistulas resulted from failure to use a vein of adequate caliber. Failure of bovine artery heterograft AV fistulas resulted either from wound infection or from the use of a diseased artery that was incapable of delivering sufficient blood to keep the fistula open. Infection around a heterograft fistula frequently was associated with a lymphocele. The meticulous division, between clips or ligatures, of all tissues deep to the skin prevented lymphocele formation.

Adolescent↗
PubMed2004

Effect of adventitial dissection in brachiobasilic arteriovenous fistulae opened in children as vascular access for hemodialysis on patency and maturation of fistulae.

BACKGROUND: Recently, therapy of pediatric patients with chronic renal failure has been carried out using hemodialysis, peritoneal dialysis, or renal transplant. In this study, we prospectively investigated the role of adventitial dissection (performed on brachiobasilic arteriovenous fistulae in the antecubital area) in the patency rate, maturation, and early initiation of dialysis among pediatric cases undergoing chronic hemodialysis. METHODS: Thirty children (7 male and 23 females) were included in this study. They were operated on at the Department of Cardiovascular Surgery of Alsancak State Hospital and Dokuz Eylul University between March 2001 and June 2003. Their mean age was 12.3 +/- 2.9 years (range 7-17 years), and their mean weight was 25.5 +/- 7.9 kg (range 16-44 kg). Children who underwent only brachiobasilic arteriovenous fistula operation were included. Group 1 (n = 15) consisted of those who underwent adventitial dissection, and group 2 (n = 15) consisted of those not receiving the adventitial dissection procedure. RESULTS: The procedure was conducted by the same surgeon, and follow-up examinations were done at the Department of Pediatric Nephrology by investigators masked to treatment groups. CONCLUSION: There were no significant differences in age, sex, existence of preoperative hypertension, diameter of vein measured preoperatively, and first day of dialysis between the groups. In 29 cases, a palpable thrill was noted at the operation site. Hemodialysis had been initiated after the fourth week, when the fistulae had matured. The mean duration of follow-up was 12.53 +/- 8.98 months in group 1 and 11.85 +/- 7.55 months in group 2 (p = .880). In group 1, one case developed fistula infection in the second month and one case developed lymphatic drainage. In group 2, one case developed early thrombosis, one case developed hematoma, and one case developed transient ischemia owing to arterial spasm in the ipsilateral limb. One case in each group developed minimal edema in the forearm, which was treated conservatively. The primary patency rate was 93.3% in both groups, whereas the secondary patency rate was 100% in group 1. Adventitial dissection performed on the vein during arteriovenous fistula formation does not result in any additional benefit with respect to fistula maturation, early initiation of dialysis, and patency. Among pediatric patients with chronic renal failure, in cases of inappropriate forearm veins, brachial arteriovenous fistulae performed with a meticulous surgical technique should be the procedure of choice because it is associated with minimal complications and a high patency rate.

Adolescent↗
PubMed1997

[A successful surgical treatment for huge left circumflex artery-right ventricle fistula using the fistula occlusion test].

A surgical case of rare coronary artery fistula between the left circumflex artery and right ventricle was reported. A 46-year-old woman had suffered from exertional dyspnea and palpitation for three years. Pan systolic heart murmur was heard through the left 4th inter costal space. The chest X-ray film demonstrated cardiac enlargement and lung congestion, and the electrocardiograms showed atrial fibrillation and left ventricular hypertrophy when she was admitted to our hospital. Preoperative catheterization revealed a huge coronary artery fistula originating from the left circumflex artery and opening into the right ventricle through the posterior wall of the heart. The left-to-right shunt ratio was 60% and Qp/Qs was 2.47. At operation, the dilated circumflex artery fistula was carefully dissected and the tape was passed around the fistula as a tourniquet under extra corporeal circulation on the beating heart. To estimate myocardial ischemia, the fistula occlusion test was performed by tightening the previously placed tourniquet. Monitoring of electrocardiograms, transesophageal echocardiography, and hemodynamics were useful to detect myocardial ischemia. The occlusion test was performed under ECC for 5 minutes. No ischemic changes were observed. The fistula was interrupted under cardiac arrest at the point of the occlusion test.

Arteriovenous Fistula↗
PubMed1977

Congenital left aortic sinus-left ventricle fistula and review of aortocardiac fistulas.

A fistula from the left aortic sinus to the left ventricle is reported that was successfully repaired using cardiopulmonary bypass. In addition, 175 cases of fistula to the heart from the aortic sinuses published in the English literature from 1839 through 1972 were studied, with particular emphasis on the 126 patients who underwent operative repair. The major cause of the fistulas (76%) was found to be rupture of a congenital aortic sinus aneurysm, usually during the third or fourth decade of life. The remainder of these fistulas to the heart consisted of simply a tract in an otherwise normal sinus. Ventricular septal defect was the most common associated defect and, when present, was nearly always related to a fistula arising from the right aortic sinus. Repair was successful in 86% of the 126 operated patients. The principles of operative treatment of these fistulas are reviewed.

Aorta, Thoracic↗
PubMed1999

Fistula advancement operation in the treatment of selected cases of persistently recurrent urethrocutaneous fistula following distal penile hypospadias repair.

BACKGROUND: Hypospadias fistula may be a persistently recurrent problem in some cases. The present paper describes a urethral mobilization procedure as a new way to solve this problem. METHODS: The procedure was performed on seven children suffering from recurrent hypospadias fistula that had failed more than once to be repaired by the classic ways of closure. Selection of suitable cases should be done intra-operatively, when urethral mobilization has successfully allowed the fistula opening to easily reach the glans top. The described procedure is an extensive urethral mobilization that advances the fistula opening to the neomeatus at the glans top through a glanular tunnel. RESULTS: The operation resulted in a straight penis with the neomeatus at the glans top in all seven children, without complications, over a period of 6-18 months follow up. CONCLUSIONS: The fistula advancement operation, as it is called by the author, can, in selected cases, solve the problem of persistently recurrent hypospadias fistula with a high success rate. Thus, the author recommends that this technique is added to urologists' armamentarium.

Follow-Up Studies↗