Iatrogenic femoral arteriovenous fistula with double connection between femoral artery and vein leading to high-output heart failure years after mitral and tricuspid valve replacement

Diagnostic and interventional cardiac catheterizations, the most common site of arterial access being the femoral artery, have increased recently [1]. Arteriovenous fistulas (AVFs) are potentially harmful but curable complications of cardiac catheterization. Since these fistulas can cause congestive heart failure and may threaten limb circulation, prompt diagnosis and appropriate treatment are essential [2]. In this report, we present a case of iatrogenic AVF both from superficial and deep femoral arteries to common femoral vein leading to progressively developing severe rightsided heart failure in a patient who had two normally functioning mechanical valves at mitral and tricuspid positions. The patient had a medical history of diagnostic cardiac catheterization at the affected limb site. Surgical repair was successfully performed, and clinical signs and symptoms diminished dramatically afterwards.