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Arteriovenous Fistulas
Arteriovenous Fistulas
WHAT IS
Arteriovenous Fistulas?
An irregular artery-vein junction can result in tumultuous blood flow, pain, swelling, and an increased risk of heart strain. Congenital or acquired, it occasionally necessitates surgical repair or interventional closure.
causes
Congenital
Penetrating trauma
Surgical or procedural creation
Latrogenic injury
erosion of an arterial aneurysm
Inflammation
Genetic disorders
symptoms
Purplish, bulging veins visible through the skin, similar to varicose veins
Swelling in the arms or legs near the fistula
A continuous buzzing or whooshing sound heard with a stethoscope over the fistula
Fatigue and decreased blood pressure
In large fistulas, symptoms of heart failure due to increased workload on the heart
Skin redness or warmth over the fistula site
In pulmonary AV fistulas, symptoms like bluish lips or fingertips, breathlessness, and clubbing of fingers
Possible gastrointestinal bleeding if the fistula is in the digestive tract
if untreated?
Heart Failure
Large AV fistulas cause increased blood flow that forces the heart to pump harder, potentially weakening the heart muscle and leading to heart failure.
Blood Clots
AV fistulas, especially in the legs, can cause blood clots that may lead to deep vein thrombosis (DVT) or pulmonary embolism, which can be life-threatening.
Leg Pain and Claudication
Lack of adequate blood flow to muscles can cause pain and cramping during walking or exercise.
Stroke
In cases of pulmonary AV fistulas, small clots can bypass filtration and enter the brain, causing a stroke.
Bleeding
AV fistulas may lead to internal bleeding, including gastrointestinal bleeding or hemorrhage in the brain.
Swelling and Skin Changes
Persistent swelling and skin discoloration near the fistula site.
diagnosis
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Physical Examination
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A healthcare provider listens with a stethoscope for a continuous humming or whooshing sound (bruit) near the fistula and feels for a vibration (thrill) over the artery and vein connection.
Duplex Ultrasound
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The most common, non-invasive imaging test that uses sound waves to visualize blood flow and detect abnormal connections between an artery and a vein.
Computed Tomography (CT) Angiogram
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Uses X-ray images and contrast dye to create detailed pictures of blood vessels and identify fistulas, especially when located deeper.
Magnetic Resonance Angiography (MRA)
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Uses magnetic fields and radio waves with contrast dye to image blood vessels and diagnose fistulas without radiation exposure.
Conventional Angiography
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An invasive procedure where contrast dye is injected directly into the blood vessels to provide precise imaging; often considered the gold standard for detailed mapping before treatment.
Additional Tests
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Blood flow measurements and oxygen content assessments may be used for assessing fistula function and hemodynamics.
