Iatrogenic coronary arteriovenous fistula during percutaneous coronary intervention: unique insight into intra-procedural management.

We report the case of a 69-year-old man who presented with worsening exertional angina where subsequent percutaneous coronary intervention resulted in a coronary arteriovenous fistula. Attempts to occlude the fistula using a relatively conservative management approach with acute reversal of intraprocedural heparin and prolonged balloon inflation unfortunately resulted in extensive coronary artery thrombosis without immediate resolution of the arteriovenous fistula. However, follow-up at 6 months revealed resolution of the fistula. This case study emphasizes the uncommon but potentially life-threatening complications of percutaneous coronary interventions with implications not only relating to the hazards of managing iatrogenic arteriovenous fistula, but reversing intraprocedural heparin using protamine, during any coronary angiogram.