Axillary Arteriovenous Fistula for Resolution of Pulmonary Arteriovenous Malformations Following Bidirectional Superior Cavopulmonary Connections

Background Pulmonary 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. Methods This 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 (SO 2 ) was recorded at 1, 2, and 6 months postoperatively, then every 3-6 months, and temporal correlations were analyzed. Results Twelve 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 SO 2 at 2 months strongly correlated with later SO 2 at 6, 12, 18, and 24 months ( P = .003, .004, .004, and .018, respectively). Conclusions Axillary 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 SO 2 can be predicted based on the first 2 months of SO 2 post-AAVF creation, as there is excellent correlation between SO 2 at the first 2 postoperative months and SO 2 at 6, 12, 18, and 24 months