A case of external iliac arteriovenous fistula and high-output cardiac failure after endovenous laser treatment of great saphenous vein

Abdominal and pelvic computed tomography scan. A, Axial scan of the abdomen demonstrating significant hepatomegaly, ascites, and inferior vena cava dilatation. B, The arterial-phase demonstrates early venous opacification indicating arteriovenous (AV) communication at the level of the external iliac artery and vein. C and D, Distal venous opacification on arterial phase consistent with AV fistula at the level of the common femoral vein and artery.

A, Angiogram with identification of arteriovenous (AV) fistula at level of external iliac artery and vein. B, Arterial tracing demonstrating a characteristic double-peaking during the systolic phase or pulsus bisferiens seen commonly in patients with aortic insufficiency, hypertrophic cardiomyopathy, and high-output cardiac failure. C, Angiogram performed following obliteration of fistula with deployment of Viabahn stents. D, Arterial tracing following obliteration of the AV fistulae resulting in a normal waveform.

A, Computed tomography scan of abdomen showing resolution of hepatomegaly, ascites, and dilatation of inferior vena cava. B-D, Computed tomography scan confirming resolution of AV fistulae with arterial dilatation evident at level of covered stents.