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\begin{document}

\title{Iatrogenic tibial arteriovenous fistula after Fogarty balloon catheter
graft thrombectomy}



\author[1]{Spyros Papadoulas}%
\author[1]{Konstantinos Moulakakis}%
\author[1]{Natasa Kouri}%
\author[2]{Francesk Mulita}%
\author[1]{Andreas Tsimpoukis}%
\author[1]{Charalampos Seretis}%
\author[1]{Panagiotis Kitrou}%
\author[1]{Konstantinos Katsanos}%
\author[1]{Stavros Kakkos}%
\affil[1]{University General Hospital of Patras}%
\affil[2]{University General Hospital of Patras Holy Mary the Help}%


\vspace{-1em}



  
  \date{May 21, 2024}


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\selectlanguage{english}
\begin{abstract}
A 75-year-old male presented with an immediately threatened grade IIb
acute ischemia of the left leg due to thrombosis of a
femoro-infrapopliteal prosthetic bypass graft. After an urgent Computed
Tomography Angiography, an urgent graft thrombectomy was performed using
a 5 Fr Fogarty catheter, which had a troublesome distal passage.%
\end{abstract}%



\sloppy


CLINICAL VIDEO

\textbf{Iatrogenic tibial arteriovenous~fistula after Fogarty balloon
catheter graft thrombectomy}

\textbf{Spyros Papadoulas\textsuperscript{1}, Konstantinos
Moulakakis\textsuperscript{1}, Natasa Kouri\textsuperscript{1}, Francesk
Mulita\textsuperscript{2}, Andreas Tsimpoukis\textsuperscript{1},
Charalampos Seretis\textsuperscript{1}, Panagiotis
Kitrou\textsuperscript{3}, Konstantinos Katsanos\textsuperscript{3},
Stavros K. Kakkos\textsuperscript{1}.}

\textsuperscript{1}Department of Vascular Surgery, University of Patras
Medical School, Patras, Greece

\textsuperscript{2}Department of Surgery, University of Patras Medical
School, Patras, Greece

\textsuperscript{3}Department of Radiology, University of Patras Medical
School, Patras, Greece

Correspondence: Spyros Papadoulas MD, PhD, Vascular Surgeon.University
of Patras Medical School, Patras, Achaia, Greece, Tel.: +30 6972211059;
E-mail: spyros.papadoulas@gmail.com; ORCID Id:\emph{https://orcid.org/}

\textbf{Key Clinical Message}

Peripheral arterial thrombo-embolectomies with a Fogarty balloon
catheter may lead to iatrogenic injuries like vessel perforation,
pseudoaneurysm or arteriovenous fistula formation, as in our case.
Fluoroscopically assisted thromboembolectomy may eliminate these
complications.

\textbf{Case Description}

A 75-year-old male presented with an immediately threatened grade IIb
acute ischemia of the left leg due to thrombosis of a
femoro-infrapopliteal prosthetic bypass graft. After an urgent Computed
Tomography Angiography, an urgent graft thrombectomy was performed using
a 5 Fr Fogarty catheter, which had a troublesome distal passage. The leg
recovered normal motor and sensory function. Surprisingly, a hand-held
Doppler device obtained a continuous machinery bruit in the anterior
tibial artery/veins suggesting an arteriovenous fistula, which was
depicted in a subsequent Digital Subtraction Angiography and a color
duplex exam (S1). Most likely, the Fogarty catheter had unintentionally
perforated the anterior tibial artery passing into one of the adjacent
anterior tibial veins {[}1-2{]}. Patient was managed conservatively and
the arteriovenous fistula was found to be spontaneously thrombosed in a
three-month follow-up (S1).

\textbf{Keywords:} Iatrogenic injury, Fogarty thrombectomy, graft
thrombectomy, arteriovenous fistula

\textbf{Patient consent for publication}

A written informed consent was obtained from the patient for publication
of this case report.

\textbf{Conflict of interest}

There are no conflicts of interest to declare.

\textbf{Financial support and sponsorship}

None

\textbf{Author contribution}

SP, KM, NK, FM, AT, CS contributed to the clinical data collection and
prepared the case report. SP, FM, PK, KK, SK contributed to the design
of the case report presentation and performed the final revision of the
manuscript.

\textbf{Data availability}

Data available on request from the authors

\textbf{References}

Shifrin EG, Anner H, Levy P, Milgalter E. Arterio-venous fistula in the
lower limb in consequence of Fogarty balloon catheter embolectomy. Case
report and review of the literature. J Cardiovasc Surg (Torino). 1985
May-Jun;26(3):310-3

A\selectlanguage{polish}ć\selectlanguage{english}inF, DeBenitoL, GuilleumaJ, Garc\selectlanguage{ngerman}íaPajaresR, MarchJR, BuenoA.Peroneal
arteriovenous fistula as a complication of above-knee femoropopliteal
polytetrafluorethylene graft thrombectomy with the Fogarty catheter. J
Cardiovasc Surg (Torino). 1996 Apr;37(2):113-5

\textbf{Hosted file}

\verb`VIDEO.mp4`  available at \url{https://authorea.com/users/440112/articles/540886-iatrogenic-tibial-arteriovenous-fistula-after-fogarty-balloon-catheter-graft-thrombectomy}

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