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Eur J Cardiothorac Surg 2002;22:163
© 2002 Elsevier Science NL

Letter to the Editor

Reply to Saad

Ansar Hassan*, Imtiaz S. Ali

1472 Tower Road, Apartment 303, Halifax, Nova Scotia, B3H 4K8, Canada

Received 7 March 2002; accepted 27 March 2002.

* Corresponding author. Tel.: +1-902-423-7760
e-mail: ahassan{at}is2.dal.ca

I thank Mr Saad for his interest in our case report describing arteriovenous fistulae involving the internal thoracic vessels [1]. Indeed, internal thoracic fistulae remain a rare complication following cardiac and non-cardiac thoracic surgery. By continuing to publish case reports on this subject, it is hoped that the diagnosis and subsequent management of internal thoracic fistulae will become increasingly recognized and accepted.

In case 1, the patient experienced a recurrence of the internal thoracic fistulae after percutaneous transcatheter embolization of the left internal thoracic artery. Only the antegrade pedicle had been embolized initially. Following recurrence of the fistula, both the antegrade and retrograde pedicles were embolized. In 3 years of subsequent follow-up, there was no evidence of recurrence. Mr Saad raises an excellent point that had we embolized both the antegrade and retrograde pedicles initially, we could have possibly prevented recurrence. This is in keeping with the recommendation from Silva et al. [2].

References

  1. Hassan A., Campbell D.R., Bethune D.C., Ali I.S. Fistulae of the internal thoracic vessels: report of two cases. Eur J Cardiothorac Surg 2002;21:358-360.[Abstract/Free Full Text]
  2. Silva J., Gonzalez-Santos J., Perez M., Ruiz M., Vallejo J.L. Iatrogenic mammary arteriovenous fistula caused by sternal wire. Ann Thorac Surg 1998;66:1398-1399.[Abstract/Free Full Text]




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Imtiaz S. Ali
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