Ibrahim Alibrahim, Ahmed Alomrani, Abdulraouf M. Z. Jijeh, Mohamed S. Kabbani, Fahad Alhabshan, Omar R. Tamimi, Faleh Alqahtani, Abdullah Alghamdi
Ministry of National Guard Health Affairs. King Abdullah International Medical Research Center. King Saud bin Abdulaziz University for Health Sciences College of Medicine. King Salman Heart Center and King Fahad Medical City.
Saudi Arabia
World Journal od Pediatric and Congenital Heart Surgery
World J Pediatr Congenit Heart Surg 2026;
DOI: 10.1177/21501351261477042
Abstract
BackgroundPulmonary arteriovenous malformations (PAVMs) are a major cause of cyanosis after bidirectional cavopulmonary connection. We evaluated the effects of axillary arteriovenous fistula (AAVF) creation in managing PAVMs.MethodsThis retrospective cohort study included patients who underwent AAVF creation from 2014 to 2022 with ≥6 months of follow-up. Patients underwent diagnostic cardiac catheterization to assess hemodynamic and angiographic response to AAVF. Oxygen saturation (SO2) was recorded at 1, 2, and 6 months postoperatively, then every 3-6 months, and temporal correlations were analyzed.ResultsTwelve patients underwent AAVF creation. Nine (75%) showed improvement; 5 proceeded to total cavopulmonary connection (Fontan), and 4 remained with AAVF as final palliation. Nine patients underwent follow-up catheterization ≥6 months after AAVF, demonstrating significant improvement in pulmonary venous saturation, aortic saturation, and McGoon ratio (P = .013, .012, and .011, respectively). Early postoperative SO2 at 2 months strongly correlated with later SO2 at 6, 12, 18, and 24 months (P = .003, .004, .004, and .018, respectively).ConclusionsAxillary arteriovenous fistula creation was effective in treating PAVMs in 75% (9/12) of our patients and was effective as a bridge to total cavopulmonary connection (TCPC) in all patients. It may be considered an alternative to TCPC when TCPC is not feasible; however, this requires validation in a larger population with longer follow-up. Finally, mid-term SO2 can be predicted based on the first 2 months of SO2 post-AAVF creation, as there is excellent correlation between SO2 at the first 2 postoperative months and SO2 at 6, 12, 18, and 24 months.
Category
Pulmonary Arteriovenous Malformations
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
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