Arteriovenous fistula: Difference between revisions
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==Overview== | ==Overview== | ||
An arteriovenous fistula is an abnormal connection or passageway between an [[artery]] and a [[vein]]. It may be [[congenital]], surgically created for [[hemodialysis]] treatments, or acquired due to [[pathology|pathologic]] process, such as [[Physical trauma|trauma]] or erosion of an arterial [[aneurysm]]. These communications can occur at any point in the vascular system; varying in size, length, location, and number. | An [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] is an abnormal connection or passageway between an [[artery]] and a [[vein]]. It may be [[congenital]], [[Surgery|surgically]] created for [[hemodialysis]] [[treatments|treatment]], or [[acquired]] due to a [[pathology|pathologic]] process, such as [[Physical trauma|trauma]] or erosion of an [[arterial]] [[aneurysm]]. These communications can occur at any point in the [[vascular system]]; varying in size, length, location, and number. | ||
==Historical Perspective== | ==Historical Perspective== | ||
*Arteriovenous fistula (AVF) was first discovered by William Hunter, in 1758, during a | *[[Arteriovenous fistulae|Arteriovenous fistula (AVF)]] was first discovered by William Hunter, in 1758, during a [[venipuncture]] with accidental piercing of the [[artery]].<ref name="pmid4682507">{{cite journal |vauthors=Khodadad G |title=Arteriovenous malformations of the scalp |journal=Ann. Surg. |volume=177 |issue=1 |pages=79–85 |date=January 1973 |pmid=4682507 |pmc=1355509 |doi= |url=}}</ref><ref name="pmid25650050">{{cite journal |vauthors=Liu J, Shimada Y |title=A Case of Intractable Left Forearm Congenital Arteriovenous Fistula Ending with Amputation: Importance of New Medical Information Obtained via the Internet |journal=J Rural Med |volume=9 |issue=1 |pages=37–9 |date=2014 |pmid=25650050 |pmc=4310049 |doi=10.2185/jrm.2878 |url=}}</ref><ref name="pmid17865813">{{cite journal |vauthors=Yater WM |title=ACQUIRED ARTERIOVENOUS FISTULA |journal=Ann. Surg. |volume=87 |issue=1 |pages=19–31 |date=January 1928 |pmid=17865813 |pmc=1398373 |doi= |url=}}</ref><ref>{{cite book | last = Olivecrona | first = Herbert | title = Congenital arteriovenous aneurysms of the carotid and vertebral arterial systems | publisher = Springer | location = Berlin | year = 1957 | isbn = 9783540022046 }}</ref> | ||
*Congenital arteriovenous fistula (AVF) of the coronary arteries, a rare cardiac anomaly, was first described by Krause W. Uber, in 1865.<ref name="pmid28423125">{{cite journal |vauthors=Albeyoglu S, Aldag M, Ciloglu U, Sargin M, Oz TK, Kutlu H, Dagsali S |title=Coronary Arteriovenous Fistulas in Adult Patients: Surgical Management and Outcomes |journal=Braz J Cardiovasc Surg |volume=32 |issue=1 |pages=15–21 |date=2017 |pmid=28423125 |pmc=5382904 |doi=10.21470/1678-9741-2017-0005 |url=}}</ref><ref name="pmid20661326">{{cite journal |vauthors=Lim WH, Kang SH, Jeon K, Cho I, Kim KH, Hwang SW, Kim HK, Sohn DW |title=Asymptomatic Right Coronary Artery-to-Pulmonary Artery Fistula Incidentally Detected by Transthoracic Echocardiography |journal=J Cardiovasc Ultrasound |volume=17 |issue=3 |pages=106–9 |date=September 2009 |pmid=20661326 |pmc=2889379 |doi=10.4250/jcu.2009.17.3.106 |url=}}</ref><ref name="pmid19119260">{{cite journal |vauthors=Jang SN, Her SH, Do KR, Kim JS, Yoon HJ, Lee JM, Jin SW |title=A case of congenital bilateral coronary-to-right ventricle fistula coexisting with variant angina |journal=Korean J. Intern. Med. |volume=23 |issue=4 |pages=216–8 |date=December 2008 |pmid=19119260 |pmc=2687685 |doi=10.3904/kjim.2008.23.4.216 |url=}}</ref> | *[[Congenital]] [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] of the [[coronary arteries]], a rare [[cardiac]] [[anomaly]], was first described by Krause W. Uber, in 1865.<ref name="pmid28423125">{{cite journal |vauthors=Albeyoglu S, Aldag M, Ciloglu U, Sargin M, Oz TK, Kutlu H, Dagsali S |title=Coronary Arteriovenous Fistulas in Adult Patients: Surgical Management and Outcomes |journal=Braz J Cardiovasc Surg |volume=32 |issue=1 |pages=15–21 |date=2017 |pmid=28423125 |pmc=5382904 |doi=10.21470/1678-9741-2017-0005 |url=}}</ref><ref name="pmid20661326">{{cite journal |vauthors=Lim WH, Kang SH, Jeon K, Cho I, Kim KH, Hwang SW, Kim HK, Sohn DW |title=Asymptomatic Right Coronary Artery-to-Pulmonary Artery Fistula Incidentally Detected by Transthoracic Echocardiography |journal=J Cardiovasc Ultrasound |volume=17 |issue=3 |pages=106–9 |date=September 2009 |pmid=20661326 |pmc=2889379 |doi=10.4250/jcu.2009.17.3.106 |url=}}</ref><ref name="pmid19119260">{{cite journal |vauthors=Jang SN, Her SH, Do KR, Kim JS, Yoon HJ, Lee JM, Jin SW |title=A case of congenital bilateral coronary-to-right ventricle fistula coexisting with variant angina |journal=Korean J. Intern. Med. |volume=23 |issue=4 |pages=216–8 |date=December 2008 |pmid=19119260 |pmc=2687685 |doi=10.3904/kjim.2008.23.4.216 |url=}}</ref> | ||
==Classification== | ==Classification== | ||
*Arteriovenous fistula (AVF) can be classified into: | *[[Arteriovenous fistulae|Arteriovenous fistula (AVF)]] can be classified into: | ||
:* | :*Spontaneous, which can be further subdivided into cirsoid/[[congenital]] and [[idiopathic]]/[[Aneurysm|aneurysmal]]. | ||
:*Acquired | :*[[Acquired]], which can be the result of a [[trauma]] or part of treatment for an underlying [[disorder]].<ref name="pmid17865813">{{cite journal |vauthors=Yater WM |title=ACQUIRED ARTERIOVENOUS FISTULA |journal=Ann. Surg. |volume=87 |issue=1 |pages=19–31 |date=January 1928 |pmid=17865813 |pmc=1398373 |doi= |url=}}</ref><ref name="pmid7953391">{{cite journal |vauthors=Robbs JV, Carrim AA, Kadwa AM, Mars M |title=Traumatic arteriovenous fistula: experience with 202 patients |journal=Br J Surg |volume=81 |issue=9 |pages=1296–9 |date=September 1994 |pmid=7953391 |doi= |url=}}</ref><ref name="pmid22477453">{{cite journal |vauthors=Nagpal K, Ahmed K, Cuschieri R |title=Diagnosis and management of acute traumatic arteriovenous fistula |journal=Int. J. Angiol. |volume=17 |issue=4 |pages=214–6 |date=2008 |pmid=22477453 |pmc=2728918 |doi= |url=}}</ref><ref name="pmid21331135">{{cite journal |vauthors=Laberge JM |title=Interventional management of renal transplant arteriovenous fistula |journal=Semin Intervent Radiol |volume=21 |issue=4 |pages=239–46 |date=December 2004 |pmid=21331135 |pmc=3036239 |doi=10.1055/s-2004-861558 |url=}}</ref> | ||
==Pathophysiology== | ==Pathophysiology== | ||
*The abnormal communication causes shunting of blood from high-pressure arterial side to the low-pressure venous side. | *The [[abnormal]] communication causes [[shunting]] of [[blood]] from high-[[pressure]] [[arterial]] side to the low-[[pressure]] [[venous]] side. | ||
* An arteriovenous fistula (AVF) involving a major artery such as the [[abdominal aorta]] can lead to a large decrease in [[peripheral resistance]], which in turn causes the heart to increase [[cardiac output]] in order to maintain proper blood flow to all tissues. | * An [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] involving a major [[artery]] such as the [[abdominal aorta]] can lead to a large decrease in [[peripheral resistance]], which in turn causes the [[heart]] to increase [[cardiac output]] in order to maintain proper [[blood]] flow to all [[tissues]]. | ||
:*The physical manifestations of this would be a relatively normal systolic [[blood pressure]] with a decreased diastolic blood pressure resulting in a wide (large) [[pulse pressure]]. | :*The physical manifestations of this would be a relatively normal [[systolic]] [[blood pressure]] with a decreased [[diastolic]] [[blood pressure]] resulting in a wide (large) [[pulse pressure]]. | ||
*Large arteriovenous fistulae (AVF) can lead to congestive heart failure associated with increased activity of vasoconstrictor neurohormonal systems, renin-angiotensin, sympathetic nervous system, endothelin system, and Arginine vasopressin.<ref name="pmid15320481">{{cite journal |vauthors=Abassi ZA, Winaver J, Hoffman A |title=Large A-V fistula: pathophysiological consequences and therapeutic perspectives |journal=Curr Vasc Pharmacol |volume=1 |issue=3 |pages=347–54 |date=October 2003 |pmid=15320481 |doi= |url=}}</ref> | *Large [[Arteriovenous fistulae|arteriovenous fistulae (AVF)]] can lead to [[congestive heart failure]] associated with increased activity of [[vasoconstrictor]] neurohormonal systems, the [[Renin-angiotensin system|renin-angiotensin]], [[sympathetic nervous system]], [[endothelin]] system, and [[Arginine vasopressin]].<ref name="pmid15320481">{{cite journal |vauthors=Abassi ZA, Winaver J, Hoffman A |title=Large A-V fistula: pathophysiological consequences and therapeutic perspectives |journal=Curr Vasc Pharmacol |volume=1 |issue=3 |pages=347–54 |date=October 2003 |pmid=15320481 |doi= |url=}}</ref> | ||
*The increased activity of vasoconstrictor neurohormonal systems is in concurrence with compensatory activation of | *The increased activity of [[vasoconstrictor]] neurohormonal systems is in concurrence with compensatory activation of the [[Vasodilation|vasodilating]] systems, the [[Atrial natriuretic peptide|atrial natriuretic peptide (ANP)]] and [[Nitric oxide|nitric oxide (NO)]]. | ||
*A fistula can progress to an aneurysm, usually in the setting of a trauma, carrying a risk of rupture and necessitating surgical intervention.<ref name="pmid25623503">{{cite journal |vauthors=Soumer K, Benomrane S, Derbel B, Laribi J, Benmrad M, Elleuch N, Kalfat T, Khayati A |title=Popliteal pseudoaneurysm and arteriovenous fistula after acupuncture |journal=J Mal Vasc |volume=40 |issue=1 |pages=58–62 |date=February 2015 |pmid=25623503 |doi=10.1016/j.jmv.2014.11.001 |url=}}</ref> | *A [[fistula]] can progress to an [[aneurysm]], usually in the setting of a [[trauma]], carrying a risk of [[rupture]] and necessitating [[Surgery|surgical]] intervention.<ref name="pmid25623503">{{cite journal |vauthors=Soumer K, Benomrane S, Derbel B, Laribi J, Benmrad M, Elleuch N, Kalfat T, Khayati A |title=Popliteal pseudoaneurysm and arteriovenous fistula after acupuncture |journal=J Mal Vasc |volume=40 |issue=1 |pages=58–62 |date=February 2015 |pmid=25623503 |doi=10.1016/j.jmv.2014.11.001 |url=}}</ref> | ||
*The malformation can result in hemorrhage and the risk is significantly higher with small size malformation because of the significantly higher feeding artery pressures.<ref name="pmid1588424">{{cite journal |vauthors=Spetzler RF, Hargraves RW, McCormick PW, Zabramski JM, Flom RA, Zimmerman RS |title=Relationship of perfusion pressure and size to risk of hemorrhage from arteriovenous malformations |journal=J. Neurosurg. |volume=76 |issue=6 |pages=918–23 |date=June 1992 |pmid=1588424 |doi=10.3171/jns.1992.76.6.0918 |url=}}</ref> | *The [[malformation]] can result in [[hemorrhage]] and the risk is significantly higher with small size [[malformation]] because of the significantly higher feeding [[artery]] [[Pressure|pressures]].<ref name="pmid1588424">{{cite journal |vauthors=Spetzler RF, Hargraves RW, McCormick PW, Zabramski JM, Flom RA, Zimmerman RS |title=Relationship of perfusion pressure and size to risk of hemorrhage from arteriovenous malformations |journal=J. Neurosurg. |volume=76 |issue=6 |pages=918–23 |date=June 1992 |pmid=1588424 |doi=10.3171/jns.1992.76.6.0918 |url=}}</ref> | ||
==Clinical Features== | ==Clinical Features== | ||
*In the case of coronary arteriovenous fistula (AVF) patients can be asymptomatic or can present with: | *In the case of a [[coronary]] [[Arteriovenous fistulae|arteriovenous fistula (AVF)]], patients can be [[asymptomatic]] or can present with: | ||
:*Continuous murmur | :*[[Continuous murmur]]<ref name="pmid26221510">{{cite journal |vauthors=Zamani H, Meragi M, Arabi Moghadam MY, Alizadeh B, Babazadeh K, Mokhtari-Esbuie F |title=Clinical presentation of coronary arteriovenous fistula according to age and anatomic orientation |journal=Caspian J Intern Med |volume=6 |issue=2 |pages=108–12 |date=2015 |pmid=26221510 |pmc=4478461 |doi= |url=}}</ref><ref name="pmid2319939">{{cite journal |vauthors=Sapin P, Frantz E, Jain A, Nichols TC, Dehmer GJ |title=Coronary artery fistula: an abnormality affecting all age groups |journal=Medicine (Baltimore) |volume=69 |issue=2 |pages=101–13 |date=March 1990 |pmid=2319939 |doi= |url=}}</ref> | ||
:*[[Cardiomegaly]] | |||
:*[[Chest pain]] | |||
:*[[Fatigue]] | |||
:*[[Palpitation]] | |||
:*[[Angina]] | |||
:*[[Bacterial endocarditis]] | |||
*Systemic hypotension<ref name="pmid21725657">{{cite journal |vauthors=Mise N, Uchida L, Tanaka M, Tanaka S, Nakajima H, Sugimoto T |title=Acute systemic hypotension after arteriovenous fistula construction in a patient with severe aortic stenosis |journal=Clin. Exp. Nephrol. |volume=15 |issue=5 |pages=788–790 |date=October 2011 |pmid=21725657 |doi=10.1007/s10157-011-0484-3 |url=}}</ref> | *[[Systemic hypotension]]<ref name="pmid21725657">{{cite journal |vauthors=Mise N, Uchida L, Tanaka M, Tanaka S, Nakajima H, Sugimoto T |title=Acute systemic hypotension after arteriovenous fistula construction in a patient with severe aortic stenosis |journal=Clin. Exp. Nephrol. |volume=15 |issue=5 |pages=788–790 |date=October 2011 |pmid=21725657 |doi=10.1007/s10157-011-0484-3 |url=}}</ref> | ||
*Fistulae involving the spinal vasculature can present with neurologic symptoms of the lower extremities which may include weakness and sensory disturbance.<ref name="pmid26711922">{{cite journal |vauthors=Asada D, Itoi T, Hamaoka K |title=Asymptomatic spinal arteriovenous fistula presenting only as continuous murmur |journal=Pediatr Int |volume=57 |issue=6 |pages=1208–10 |date=December 2015 |pmid=26711922 |doi=10.1111/ped.12716 |url=}}</ref> | *[[Fistulae]] involving the [[Spine|spinal]] [[vasculature]] can present with [[neurologic]] [[Symptom|symptoms]] of the [[lower extremities]] which may include [[weakness]] and [[sensory]] disturbance.<ref name="pmid26711922">{{cite journal |vauthors=Asada D, Itoi T, Hamaoka K |title=Asymptomatic spinal arteriovenous fistula presenting only as continuous murmur |journal=Pediatr Int |volume=57 |issue=6 |pages=1208–10 |date=December 2015 |pmid=26711922 |doi=10.1111/ped.12716 |url=}}</ref> | ||
*Acquired arteriovenous fistula (AVF) can result in digital clubbing.<ref name="pmid660832">{{cite journal |vauthors=Leb DE, Sharma JK |title=Clubbing secondary to an arteriovenous fistula used for hemodialysis |journal=JAMA |volume=240 |issue=2 |pages=142–3 |date=July 1978 |pmid=660832 |doi= |url=}}</ref> | *[[Acquired]] [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] can result in [[digital clubbing]].<ref name="pmid660832">{{cite journal |vauthors=Leb DE, Sharma JK |title=Clubbing secondary to an arteriovenous fistula used for hemodialysis |journal=JAMA |volume=240 |issue=2 |pages=142–3 |date=July 1978 |pmid=660832 |doi= |url=}}</ref> | ||
*Patients on hemodialysis with arteriovenous fistula (AVF) can develop pseudo-Kaposi's sarcoma.<ref name="pmid10606867">{{cite journal |vauthors=Hwang SM, Lee SH, Ahn SK |title=Pincer nail deformity and pseudo-Kaposi's sarcoma: complications of an artificial arteriovenous fistula for haemodialysis |journal=Br. J. Dermatol. |volume=141 |issue=6 |pages=1129–32 |date=December 1999 |pmid=10606867 |doi= |url=}}</ref> | *[[Patient|Patients]] on [[hemodialysis]] with [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] can develop pseudo-[[Kaposi's sarcoma]].<ref name="pmid10606867">{{cite journal |vauthors=Hwang SM, Lee SH, Ahn SK |title=Pincer nail deformity and pseudo-Kaposi's sarcoma: complications of an artificial arteriovenous fistula for haemodialysis |journal=Br. J. Dermatol. |volume=141 |issue=6 |pages=1129–32 |date=December 1999 |pmid=10606867 |doi= |url=}}</ref> | ||
*Abdominal arteriovenous fistulae can present with: | *[[Abdominal]] [[arteriovenous fistulae]] can present with: | ||
:*Lower extremity edema with cyanosis | :*[[Lower extremity]] [[edema]] with [[cyanosis]] | ||
:*Pulsatile varicose veins | :*Pulsatile [[varicose veins]] | ||
:*Scrotal edema<ref name="pmid21838084">{{cite journal |vauthors=Scruggs J, Bennett DD |title=Cutaneous manifestations of abdominal arteriovenous fistulas |journal=Cutis |volume=87 |issue=6 |pages=284–6 |date=June 2011 |pmid=21838084 |doi= |url=}}</ref> | :*[[Scrotum|Scrotal]] [[edema]]<ref name="pmid21838084">{{cite journal |vauthors=Scruggs J, Bennett DD |title=Cutaneous manifestations of abdominal arteriovenous fistulas |journal=Cutis |volume=87 |issue=6 |pages=284–6 |date=June 2011 |pmid=21838084 |doi= |url=}}</ref> | ||
*Ilio-iliac arteriovenous fistula (AVF) presents with progressive abdominal distention, dyspnea, and | *[[Iliac|Ilio]]-[[iliac]] [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] presents with progressive [[Abdominal distension|abdominal distention]], [[dyspnea]], and [[edema]] of the [[leg]], which makes it difficult to distinguish from [[Deep venous thrombosis|deep venous thrombosis (DVT)]] and can lead to a delay in the [[diagnosis]].<ref name="pmid25432380">{{cite journal |vauthors=Li Y, Fu Q, Liu A, Zheng Z, Fan W, Zhu Z, Chen L, Dai W |title=[A case of iatrogenic ilio-iliac arteriovenous fistula initially misdiagnosed as deep venous thrombosis] |language=Chinese |journal=Zhong Nan Da Xue Xue Bao Yi Xue Ban |volume=39 |issue=11 |pages=1217–20 |date=November 2014 |pmid=25432380 |doi=10.11817/j.issn.1672-7347.2014.11.019 |url=}}</ref> | ||
*Tentorial dural arteriovenous fistula (AVF) can rarely manifest as trigeminal neuralgia.<ref name="pmid24285803">{{cite journal |vauthors=Lu X, Qin X, Ni L, Chen J, Xu F |title=Tentorial dural arteriovenous fistula manifesting as contralateral trigeminal neuralgia: resolution after transarterial Onyx embolization |journal=BMJ Case Rep |volume=2013 |issue= |pages= |date=November 2013 |pmid=24285803 |pmc=3847479 |doi=10.1136/bcr-2013-010984 |url=}}</ref> | *[[Tentorium|Tentorial]] [[Dural arteriovenous fistula|dural arteriovenous fistula (AVF)]] can rarely manifest as [[trigeminal neuralgia]].<ref name="pmid24285803">{{cite journal |vauthors=Lu X, Qin X, Ni L, Chen J, Xu F |title=Tentorial dural arteriovenous fistula manifesting as contralateral trigeminal neuralgia: resolution after transarterial Onyx embolization |journal=BMJ Case Rep |volume=2013 |issue= |pages= |date=November 2013 |pmid=24285803 |pmc=3847479 |doi=10.1136/bcr-2013-010984 |url=}}</ref> | ||
==Differentiating Arteriovenous Fistula (AVF) from other Conditions== | ==Differentiating Arteriovenous Fistula (AVF) from other Conditions== | ||
*It is important to differentiate an arteriovenous fistula (AVF) from other conditions that cause a hyperdynamic circulation such as: | *It is important to differentiate an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] from other conditions that cause a [[hyperdynamic circulation]] such as: | ||
:* | :*[[Cirrhosis]]<ref name="pmid8462804">{{cite journal |vauthors=Fernández-Rodriguez CM, Prieto J, Zozaya JM, Quiroga J, Guitián R |title=Arteriovenous shunting, hemodynamic changes, and renal sodium retention in liver cirrhosis |journal=Gastroenterology |volume=104 |issue=4 |pages=1139–45 |date=April 1993 |pmid=8462804 |doi= |url=}}</ref> | ||
:*Graves | :*[[Graves ophthalmopathy]]<ref name="pmid23571267">{{cite journal |vauthors=Celik O, Buyuktas D, Islak C, Sarici AM, Gundogdu AS |title=The association of carotid cavernous fistula with Graves' ophthalmopathy |journal=Indian J Ophthalmol |volume=61 |issue=7 |pages=349–51 |date=July 2013 |pmid=23571267 |pmc=3759106 |doi=10.4103/0301-4738.109533 |url=}}</ref> | ||
:*Various sarcomas such as, angiosarcoma and leiomyosarcoma.<ref name="pmid26482509">{{cite journal |vauthors=Oskrochi Y, Razi K, Stebbing J, Crane J |title=Angiosarcoma and Dialysis-related Arteriovenous Fistulae: A Comprehensive Review |journal=Eur J Vasc Endovasc Surg |volume=51 |issue=1 |pages=127–33 |date=January 2016 |pmid=26482509 |doi=10.1016/j.ejvs.2015.08.016 |url=}}</ref><ref name="pmid6861080">{{cite journal |vauthors=Weinreb W, Steinfeld A, Rodil J, Esparza A, Trebbin W |title=Leiomyosarcoma arising in an arteriovenous fistula |journal=Cancer |volume=52 |issue=2 |pages=390–2 |date=July 1983 |pmid=6861080 |doi= |url=}}</ref> | :*Various [[Sarcoma|sarcomas]] such as, [[angiosarcoma]] and [[leiomyosarcoma]].<ref name="pmid26482509">{{cite journal |vauthors=Oskrochi Y, Razi K, Stebbing J, Crane J |title=Angiosarcoma and Dialysis-related Arteriovenous Fistulae: A Comprehensive Review |journal=Eur J Vasc Endovasc Surg |volume=51 |issue=1 |pages=127–33 |date=January 2016 |pmid=26482509 |doi=10.1016/j.ejvs.2015.08.016 |url=}}</ref><ref name="pmid6861080">{{cite journal |vauthors=Weinreb W, Steinfeld A, Rodil J, Esparza A, Trebbin W |title=Leiomyosarcoma arising in an arteriovenous fistula |journal=Cancer |volume=52 |issue=2 |pages=390–2 |date=July 1983 |pmid=6861080 |doi= |url=}}</ref> | ||
:*Paget's disease of bone<ref name="pmid5055421">{{cite journal |vauthors=Putschar WG |title=Circulation in Paget's disease of bone |journal=N. Engl. J. Med. |volume=287 |issue=14 |pages=717–8 |date=October 1972 |pmid=5055421 |doi=10.1056/NEJM197210052871410 |url=}}</ref><ref name="pmid13117640">{{cite journal |vauthors=STORSTEEN KA, JANES JM |title=Arteriography and vascular studies in Paget's disease of bone |journal=J Am Med Assoc |volume=154 |issue=6 |pages=472–4 |date=February 1954 |pmid=13117640 |doi= |url=}}</ref> | :*[[Paget's disease of bone]]<ref name="pmid5055421">{{cite journal |vauthors=Putschar WG |title=Circulation in Paget's disease of bone |journal=N. Engl. J. Med. |volume=287 |issue=14 |pages=717–8 |date=October 1972 |pmid=5055421 |doi=10.1056/NEJM197210052871410 |url=}}</ref><ref name="pmid13117640">{{cite journal |vauthors=STORSTEEN KA, JANES JM |title=Arteriography and vascular studies in Paget's disease of bone |journal=J Am Med Assoc |volume=154 |issue=6 |pages=472–4 |date=February 1954 |pmid=13117640 |doi= |url=}}</ref> | ||
*An ilio-iliac arteriovenous fistula (AVF) can lead to a misdiagnosis of deep venous thrombosis (DVT)<ref name="pmid25432380">{{cite journal |vauthors=Li Y, Fu Q, Liu A, Zheng Z, Fan W, Zhu Z, Chen L, Dai W |title=[A case of iatrogenic ilio-iliac arteriovenous fistula initially misdiagnosed as deep venous thrombosis] |language=Chinese |journal=Zhong Nan Da Xue Xue Bao Yi Xue Ban |volume=39 |issue=11 |pages=1217–20 |date=November 2014 |pmid=25432380 |doi=10.11817/j.issn.1672-7347.2014.11.019 |url=}}</ref> | *An [[Iliac|ilio]]-[[iliac]] [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] can lead to a [[misdiagnosis]] of [[Deep venous thrombosis|deep venous thrombosis (DVT)]]<ref name="pmid25432380">{{cite journal |vauthors=Li Y, Fu Q, Liu A, Zheng Z, Fan W, Zhu Z, Chen L, Dai W |title=[A case of iatrogenic ilio-iliac arteriovenous fistula initially misdiagnosed as deep venous thrombosis] |language=Chinese |journal=Zhong Nan Da Xue Xue Bao Yi Xue Ban |volume=39 |issue=11 |pages=1217–20 |date=November 2014 |pmid=25432380 |doi=10.11817/j.issn.1672-7347.2014.11.019 |url=}}</ref> | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
*In a Scottish population-based study, the incidence of dural arteriovenous fistulae in adults was 0.16 per 100 000 per year.<ref name="pmid28552162">{{cite journal |vauthors=Elhammady MS, Ambekar S, Heros RC |title=Epidemiology, clinical presentation, diagnostic evaluation, and prognosis of cerebral dural arteriovenous fistulas |journal=Handb Clin Neurol |volume=143 |issue= |pages=99–105 |date=2017 |pmid=28552162 |doi=10.1016/B978-0-444-63640-9.00009-6 |url=}}</ref><ref name="pmid5350675">{{cite journal |vauthors=Newton TH, Cronqvist S |title=Involvement of dural arteries in intracranial arteriovenous malformations |journal=Radiology |volume=93 |issue=5 |pages=1071–8 |date=November 1969 |pmid=5350675 |doi=10.1148/93.5.1071 |url=}}</ref> | *In a Scottish population-based study, the [[incidence]] of [[Dural arteriovenous fistula|dural arteriovenous fistulae]] in adults was 0.16 per 100 000 per year.<ref name="pmid28552162">{{cite journal |vauthors=Elhammady MS, Ambekar S, Heros RC |title=Epidemiology, clinical presentation, diagnostic evaluation, and prognosis of cerebral dural arteriovenous fistulas |journal=Handb Clin Neurol |volume=143 |issue= |pages=99–105 |date=2017 |pmid=28552162 |doi=10.1016/B978-0-444-63640-9.00009-6 |url=}}</ref><ref name="pmid5350675">{{cite journal |vauthors=Newton TH, Cronqvist S |title=Involvement of dural arteries in intracranial arteriovenous malformations |journal=Radiology |volume=93 |issue=5 |pages=1071–8 |date=November 1969 |pmid=5350675 |doi=10.1148/93.5.1071 |url=}}</ref> | ||
*In an Olmsted County, Minnesota-based study, the incidence and prevalence of dural arteriovenous fistulae from 1965-1992 are as follows: | *In an Olmsted County, Minnesota-based study, the [[incidence]] and [[prevalence]] of [[Dural arteriovenous fistula|dural arteriovenous fistulae]] from 1965-1992 are as follows: | ||
:*From 1965-1992, the incidence was estimated to be 1.84 cases per 100,000 individuals. | :*From 1965-1992, the [[incidence]] was estimated to be 1.84 cases per 100,000 individuals. | ||
:*From 1985-1992, the incidence was estimated to be 2.75 cases per 100,000 individuals. | :*From 1985-1992, the [[incidence]] was estimated to be 2.75 cases per 100,000 individuals. | ||
:*On | :*On January 1, 1990, the [[prevalence]] of identified cases was 19.0 per 100,000 individuals.<ref name="pmid8780070">{{cite journal |vauthors=Brown RD, Wiebers DO, Torner JC, O'Fallon WM |title=Incidence and prevalence of intracranial vascular malformations in Olmsted County, Minnesota, 1965 to 1992 |journal=Neurology |volume=46 |issue=4 |pages=949–52 |date=April 1996 |pmid=8780070 |doi= |url=}}</ref> | ||
===Age=== | ===Age=== | ||
*Individuals of all age groups may acquire the condition. | *Individuals of all age groups may acquire the condition. | ||
*Congenital | *[[Congenital]] [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] is present at birth and may manifest early or later in life. | ||
===Gender=== | ===Gender=== | ||
*Arteriovenous fistula (AVF) is observed in both men and women equally. | *[[Arteriovenous fistulae|Arteriovenous fistula (AVF)]] is observed in both [[men]] and women equally. | ||
===Race=== | ===Race=== | ||
*There is no racial predilection for arteriovenous fistula (AVF). | *There is no racial predilection for an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]]. | ||
==Risk Factors== | ==Risk Factors== | ||
*Common risk factors for the development of an arteriovenous fistula (AVF): | *Common risk factors for the [[development]] of an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]]: | ||
:*Arterial catheterization<ref name="pmid2783816">{{cite journal |vauthors=Altin RS, Flicker S, Naidech HJ |title=Pseudoaneurysm and arteriovenous fistula after femoral artery catheterization: association with low femoral punctures |journal=AJR Am J Roentgenol |volume=152 |issue=3 |pages=629–31 |date=March 1989 |pmid=2783816 |doi=10.2214/ajr.152.3.629 |url=}}</ref><ref name="pmid23609100">{{cite journal |vauthors=Sugahara T, Azuma M, Nakashima K, Ito K, Suzuki R, Hagio K, Uetani H, Yanaga Y, Baba Y |title=Postcatheterization radial arteriovenous fistula: balloon-assisted direct percutaneous embolization with N-butyl cyanoacrylate and 50 % glucose solution in two sessions |journal=Jpn J Radiol |volume=31 |issue=7 |pages=505–10 |date=July 2013 |pmid=23609100 |doi=10.1007/s11604-013-0206-8 |url=}}</ref><ref name="pmid12714202">{{cite journal |vauthors=Perings SM, Kelm M, Jax T, Strauer BE |title=A prospective study on incidence and risk factors of arteriovenous fistulae following transfemoral cardiac catheterization |journal=Int. J. Cardiol. |volume=88 |issue=2-3 |pages=223–8 |date=April 2003 |pmid=12714202 |doi= |url=}}</ref><ref name="pmid3993595">{{cite journal |vauthors=Kron J, Sutherland D, Rosch J, Morton MJ, McAnulty JH |title=Arteriovenous fistula: a rare complication of arterial puncture for cardiac catheterization |journal=Am. J. Cardiol. |volume=55 |issue=11 |pages=1445–6 |date=May 1985 |pmid=3993595 |doi= |url=}}</ref><ref name="pmid2818187">{{cite journal |vauthors=Glaser RL, McKellar D, Scher KS |title=Arteriovenous fistulas after cardiac catheterization |journal=Arch Surg |volume=124 |issue=11 |pages=1313–5 |date=November 1989 |pmid=2818187 |doi= |url=}}</ref><ref name="pmid8076015">{{cite journal |vauthors=Sidawy AN, Neville RF, Adib H, Curry KM |title=Femoral arteriovenous fistula following cardiac catheterization: an anatomic explanation |journal=Cardiovasc Surg |volume=1 |issue=2 |pages=134–7 |date=April 1993 |pmid=8076015 |doi= |url=}}</ref><ref name="pmid1544161">{{cite journal |vauthors=Kim D, Orron DE, Skillman JJ, Kent KC, Porter DH, Schlam BW, Carrozza J, Reis GJ, Baim DS |title=Role of superficial femoral artery puncture in the development of pseudoaneurysm and arteriovenous fistula complicating percutaneous transfemoral cardiac catheterization |journal=Cathet Cardiovasc Diagn |volume=25 |issue=2 |pages=91–7 |date=February 1992 |pmid=1544161 |doi= |url=}}</ref><ref name="pmid23847386">{{cite journal |vauthors=Groth KA, Erik Nielsen-Kudsk J, Nørgaard BL, Andersen NH |title=Internal mammary arteriovenous fistula found late after aortic root replacement |journal=Eur Heart J Cardiovasc Imaging |volume=14 |issue=8 |pages=831 |date=August 2013 |pmid=23847386 |doi=10.1093/ehjci/jet025 |url=}}</ref><ref name="pmid17449120">{{cite journal |vauthors=Kawano Y, Tamura A, Kadota J |title=An unusual femoral arteriovenous fistula following cardiac catheterization |journal=Int. J. Cardiol. |volume=119 |issue=1 |pages=e17–8 |date=June 2007 |pmid=17449120 |doi=10.1016/j.ijcard.2007.01.080 |url=}}</ref><ref name="pmid29235152">{{cite journal |vauthors=Nagata T, Johno H |title=Radial arteriovenous fistula following coronary angiography |journal=J Card Surg |volume=32 |issue=12 |pages=805–806 |date=December 2017 |pmid=29235152 |doi=10.1111/jocs.13257 |url=}}</ref> | :*[[Arterial]] [[catheterization]]<ref name="pmid2783816">{{cite journal |vauthors=Altin RS, Flicker S, Naidech HJ |title=Pseudoaneurysm and arteriovenous fistula after femoral artery catheterization: association with low femoral punctures |journal=AJR Am J Roentgenol |volume=152 |issue=3 |pages=629–31 |date=March 1989 |pmid=2783816 |doi=10.2214/ajr.152.3.629 |url=}}</ref><ref name="pmid23609100">{{cite journal |vauthors=Sugahara T, Azuma M, Nakashima K, Ito K, Suzuki R, Hagio K, Uetani H, Yanaga Y, Baba Y |title=Postcatheterization radial arteriovenous fistula: balloon-assisted direct percutaneous embolization with N-butyl cyanoacrylate and 50 % glucose solution in two sessions |journal=Jpn J Radiol |volume=31 |issue=7 |pages=505–10 |date=July 2013 |pmid=23609100 |doi=10.1007/s11604-013-0206-8 |url=}}</ref><ref name="pmid12714202">{{cite journal |vauthors=Perings SM, Kelm M, Jax T, Strauer BE |title=A prospective study on incidence and risk factors of arteriovenous fistulae following transfemoral cardiac catheterization |journal=Int. J. Cardiol. |volume=88 |issue=2-3 |pages=223–8 |date=April 2003 |pmid=12714202 |doi= |url=}}</ref><ref name="pmid3993595">{{cite journal |vauthors=Kron J, Sutherland D, Rosch J, Morton MJ, McAnulty JH |title=Arteriovenous fistula: a rare complication of arterial puncture for cardiac catheterization |journal=Am. J. Cardiol. |volume=55 |issue=11 |pages=1445–6 |date=May 1985 |pmid=3993595 |doi= |url=}}</ref><ref name="pmid2818187">{{cite journal |vauthors=Glaser RL, McKellar D, Scher KS |title=Arteriovenous fistulas after cardiac catheterization |journal=Arch Surg |volume=124 |issue=11 |pages=1313–5 |date=November 1989 |pmid=2818187 |doi= |url=}}</ref><ref name="pmid8076015">{{cite journal |vauthors=Sidawy AN, Neville RF, Adib H, Curry KM |title=Femoral arteriovenous fistula following cardiac catheterization: an anatomic explanation |journal=Cardiovasc Surg |volume=1 |issue=2 |pages=134–7 |date=April 1993 |pmid=8076015 |doi= |url=}}</ref><ref name="pmid1544161">{{cite journal |vauthors=Kim D, Orron DE, Skillman JJ, Kent KC, Porter DH, Schlam BW, Carrozza J, Reis GJ, Baim DS |title=Role of superficial femoral artery puncture in the development of pseudoaneurysm and arteriovenous fistula complicating percutaneous transfemoral cardiac catheterization |journal=Cathet Cardiovasc Diagn |volume=25 |issue=2 |pages=91–7 |date=February 1992 |pmid=1544161 |doi= |url=}}</ref><ref name="pmid23847386">{{cite journal |vauthors=Groth KA, Erik Nielsen-Kudsk J, Nørgaard BL, Andersen NH |title=Internal mammary arteriovenous fistula found late after aortic root replacement |journal=Eur Heart J Cardiovasc Imaging |volume=14 |issue=8 |pages=831 |date=August 2013 |pmid=23847386 |doi=10.1093/ehjci/jet025 |url=}}</ref><ref name="pmid17449120">{{cite journal |vauthors=Kawano Y, Tamura A, Kadota J |title=An unusual femoral arteriovenous fistula following cardiac catheterization |journal=Int. J. Cardiol. |volume=119 |issue=1 |pages=e17–8 |date=June 2007 |pmid=17449120 |doi=10.1016/j.ijcard.2007.01.080 |url=}}</ref><ref name="pmid29235152">{{cite journal |vauthors=Nagata T, Johno H |title=Radial arteriovenous fistula following coronary angiography |journal=J Card Surg |volume=32 |issue=12 |pages=805–806 |date=December 2017 |pmid=29235152 |doi=10.1111/jocs.13257 |url=}}</ref> | ||
:*Venous catheterization<ref name="pmid8750133">{{cite journal |vauthors=Ricolfi F, Valiente E, Bodson F, Poquet E, Chiras J, Gaston A |title=Arteriovenous fistulae complicating central venous catheterization: value of endovascular treatment based on a series of seven cases |journal=Intensive Care Med |volume=21 |issue=12 |pages=1043–7 |date=December 1995 |pmid=8750133 |doi= |url=}}</ref><ref name="pmid16986396">{{cite journal |vauthors=Tran HS, Burrows BJ, Zang WA, Han DC |title=Brachial arteriovenous fistula as a complication of placement of a peripherally inserted central venous catheter: a case report and review of the literature |journal=Am Surg |volume=72 |issue=9 |pages=833–6 |date=September 2006 |pmid=16986396 |doi= |url=}}</ref><ref name="pmid5115025">{{cite journal |vauthors=Thadani U, Pratt AE |title=Profunda femoral arteriovenous fistula after percutaneous arterial and venous catheterization |journal=Br Heart J |volume=33 |issue=5 |pages=803–5 |date=September 1971 |pmid=5115025 |pmc=487256 |doi= |url=}}</ref><ref name="pmid22415906">{{cite journal |vauthors=Chan CC, Lee V, Chu W, Tam YH, Li CK, Shing MM |title=Carotid jugular arteriovenous fistula: an unusual complication of internal jugular vein catheterization in children |journal=Pediatr Blood Cancer |volume=59 |issue=7 |pages=1302–4 |date=December 2012 |pmid=22415906 |doi=10.1002/pbc.24137 |url=}}</ref> | :*[[Venous]] [[catheterization]]<ref name="pmid8750133">{{cite journal |vauthors=Ricolfi F, Valiente E, Bodson F, Poquet E, Chiras J, Gaston A |title=Arteriovenous fistulae complicating central venous catheterization: value of endovascular treatment based on a series of seven cases |journal=Intensive Care Med |volume=21 |issue=12 |pages=1043–7 |date=December 1995 |pmid=8750133 |doi= |url=}}</ref><ref name="pmid16986396">{{cite journal |vauthors=Tran HS, Burrows BJ, Zang WA, Han DC |title=Brachial arteriovenous fistula as a complication of placement of a peripherally inserted central venous catheter: a case report and review of the literature |journal=Am Surg |volume=72 |issue=9 |pages=833–6 |date=September 2006 |pmid=16986396 |doi= |url=}}</ref><ref name="pmid5115025">{{cite journal |vauthors=Thadani U, Pratt AE |title=Profunda femoral arteriovenous fistula after percutaneous arterial and venous catheterization |journal=Br Heart J |volume=33 |issue=5 |pages=803–5 |date=September 1971 |pmid=5115025 |pmc=487256 |doi= |url=}}</ref><ref name="pmid22415906">{{cite journal |vauthors=Chan CC, Lee V, Chu W, Tam YH, Li CK, Shing MM |title=Carotid jugular arteriovenous fistula: an unusual complication of internal jugular vein catheterization in children |journal=Pediatr Blood Cancer |volume=59 |issue=7 |pages=1302–4 |date=December 2012 |pmid=22415906 |doi=10.1002/pbc.24137 |url=}}</ref> | ||
:*Hypertension<ref name="pmid19629281">{{cite journal |vauthors=Melo NC, Mundim JS, Costalonga EC, Lucon AM, Santello JL, Praxedes JN |title=Three cases of hypertension and renal arteriovenous fistula with a de novo fistula |journal=Arq. Bras. Cardiol. |volume=92 |issue=5 |pages=e36–8, e63–5 |date=May 2009 |pmid=19629281 |doi= |url=}}</ref><ref name="pmid5091842">{{cite journal |vauthors=McAlhany JC, Black HC, Hanback LD, Yarbrough DR |title=Renal arteriovenous fistula as a cause of hypertension |journal=Am. J. Surg. |volume=122 |issue=1 |pages=117–20 |date=July 1971 |pmid=5091842 |doi= |url=}}</ref><ref name="pmid23882900">{{cite journal |vauthors=Goldberg A, Tsipis A, Rosenfeld I |title=Arteriovenous fistula after cardiac catheterization from a radial approach |journal=Isr. Med. Assoc. J. |volume=15 |issue=6 |pages=313–4 |date=June 2013 |pmid=23882900 |doi= |url=}}</ref><ref name="DoblasCuesta2016">{{cite journal|last1=Doblas|first1=M.|last2=Cuesta|first2=M. A.|last3=Garcia|first3=L. Garcia|last4=Diaz|first4=E. Garcia|last5=Bengoechea|first5=E.|title=Distal Venous Hypertension in Side-to-Side Arteriovenous Fistulae|journal=Phlebology: The Journal of Venous Disease|volume=3|issue=2|year=2016|pages=135–138|issn=0268-3555|doi=10.1177/026835558800300211}}</ref> | :*[[Hypertension]]<ref name="pmid19629281">{{cite journal |vauthors=Melo NC, Mundim JS, Costalonga EC, Lucon AM, Santello JL, Praxedes JN |title=Three cases of hypertension and renal arteriovenous fistula with a de novo fistula |journal=Arq. Bras. Cardiol. |volume=92 |issue=5 |pages=e36–8, e63–5 |date=May 2009 |pmid=19629281 |doi= |url=}}</ref><ref name="pmid5091842">{{cite journal |vauthors=McAlhany JC, Black HC, Hanback LD, Yarbrough DR |title=Renal arteriovenous fistula as a cause of hypertension |journal=Am. J. Surg. |volume=122 |issue=1 |pages=117–20 |date=July 1971 |pmid=5091842 |doi= |url=}}</ref><ref name="pmid23882900">{{cite journal |vauthors=Goldberg A, Tsipis A, Rosenfeld I |title=Arteriovenous fistula after cardiac catheterization from a radial approach |journal=Isr. Med. Assoc. J. |volume=15 |issue=6 |pages=313–4 |date=June 2013 |pmid=23882900 |doi= |url=}}</ref><ref name="DoblasCuesta2016">{{cite journal|last1=Doblas|first1=M.|last2=Cuesta|first2=M. A.|last3=Garcia|first3=L. Garcia|last4=Diaz|first4=E. Garcia|last5=Bengoechea|first5=E.|title=Distal Venous Hypertension in Side-to-Side Arteriovenous Fistulae|journal=Phlebology: The Journal of Venous Disease|volume=3|issue=2|year=2016|pages=135–138|issn=0268-3555|doi=10.1177/026835558800300211}}</ref> | ||
:*Intravenous (IV) drug abuse<ref name="pmid26829963">{{cite journal |vauthors=Jonasson SA, Jøssang DE, Haaverstad R, Wendelbo Ø, Pedersen G |title=Arteriovenous fistula of the groin in a drug abuser with endocarditis |journal=J Surg Case Rep |volume=2016 |issue=2 |pages= |date=February 2016 |pmid=26829963 |pmc=5654361 |doi=10.1093/jscr/rjw001 |url=}}</ref><ref name="pmid946848">{{cite journal |vauthors=Gabow P, de Torrente A, Holt S, Kelly GL |title=Arteriovenous fistula from drug abuse. Implications for hemodialysis |journal=JAMA |volume=235 |issue=20 |pages=2220–1 |date=May 1976 |pmid=946848 |doi= |url=}}</ref> | :*[[Intravenous|Intravenous (IV)]] [[drug abuse]]<ref name="pmid26829963">{{cite journal |vauthors=Jonasson SA, Jøssang DE, Haaverstad R, Wendelbo Ø, Pedersen G |title=Arteriovenous fistula of the groin in a drug abuser with endocarditis |journal=J Surg Case Rep |volume=2016 |issue=2 |pages= |date=February 2016 |pmid=26829963 |pmc=5654361 |doi=10.1093/jscr/rjw001 |url=}}</ref><ref name="pmid946848">{{cite journal |vauthors=Gabow P, de Torrente A, Holt S, Kelly GL |title=Arteriovenous fistula from drug abuse. Implications for hemodialysis |journal=JAMA |volume=235 |issue=20 |pages=2220–1 |date=May 1976 |pmid=946848 |doi= |url=}}</ref> | ||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
*[[Patients]] can remain [[asymptomatic]] or can present with [[Symptom| | |||
==Diagnosis== | ==Diagnosis== | ||
===Diagnostic Criteria=== | ===Diagnostic Criteria=== | ||
*An arteriovenous fistula (AVF) can be detected by a stethoscope and can present with a machinery murmur.<ref name="pmid9532847">{{cite journal |vauthors=Baptista-Silva JC, de Figueiredo LF, Castro MJ, Veríssimo MJ, Camara AL |title=Postnephrectomy arteriovenous fistula |journal=Sao Paulo Med J |volume=115 |issue=3 |pages=1444–7 |date=1997 |pmid=9532847 |doi= |url=}}</ref><ref name="pmid3160298">{{cite journal |vauthors=Linder F |title=Acquired arterio-venous fistulas. Report of 223 operated cases |journal=Ann Chir Gynaecol |volume=74 |issue=1 |pages=1–5 |date=1985 |pmid=3160298 |doi= |url=}}</ref><ref name="pmid26711922">{{cite journal |vauthors=Asada D, Itoi T, Hamaoka K |title=Asymptomatic spinal arteriovenous fistula presenting only as continuous murmur |journal=Pediatr Int |volume=57 |issue=6 |pages=1208–10 |date=December 2015 |pmid=26711922 |doi=10.1111/ped.12716 |url=}}</ref><ref name="pmid25569414">{{cite journal |vauthors=Kim JH, Yoon SM, Choi HJ |title=Iatrogenic arteriovenous fistula of the superficial temporal artery after reduction malarplasty |journal=J Craniofac Surg |volume=26 |issue=1 |pages=e50–1 |date=January 2015 |pmid=25569414 |doi=10.1097/SCS.0000000000001312 |url=}}</ref> | *An [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] can be detected by a [[stethoscope]] and can present with a machinery-like [[murmur]].<ref name="pmid9532847">{{cite journal |vauthors=Baptista-Silva JC, de Figueiredo LF, Castro MJ, Veríssimo MJ, Camara AL |title=Postnephrectomy arteriovenous fistula |journal=Sao Paulo Med J |volume=115 |issue=3 |pages=1444–7 |date=1997 |pmid=9532847 |doi= |url=}}</ref><ref name="pmid3160298">{{cite journal |vauthors=Linder F |title=Acquired arterio-venous fistulas. Report of 223 operated cases |journal=Ann Chir Gynaecol |volume=74 |issue=1 |pages=1–5 |date=1985 |pmid=3160298 |doi= |url=}}</ref><ref name="pmid26711922">{{cite journal |vauthors=Asada D, Itoi T, Hamaoka K |title=Asymptomatic spinal arteriovenous fistula presenting only as continuous murmur |journal=Pediatr Int |volume=57 |issue=6 |pages=1208–10 |date=December 2015 |pmid=26711922 |doi=10.1111/ped.12716 |url=}}</ref><ref name="pmid25569414">{{cite journal |vauthors=Kim JH, Yoon SM, Choi HJ |title=Iatrogenic arteriovenous fistula of the superficial temporal artery after reduction malarplasty |journal=J Craniofac Surg |volume=26 |issue=1 |pages=e50–1 |date=January 2015 |pmid=25569414 |doi=10.1097/SCS.0000000000001312 |url=}}</ref> | ||
*A more superficial fistula can also be detected by palpation, presenting as continuous vibration.<ref name="pmid24598790">{{cite journal |vauthors=Iglesias Escalera G, Diaz-Delgado Peñas R, Carrasco Marina ML, Maraña Perez A, Ialeggio D |title=[A vertebral arteriovenous fistula diagnosed by auscultation] |language=Spanish; Castilian |journal=An Pediatr (Barc) |volume=82 |issue=1 |pages=e98–e101 |date=January 2015 |pmid=24598790 |doi=10.1016/j.anpedi.2013.12.011 |url=}}</ref> | *A more [[superficial]] [[fistula]] can also be detected by [[palpation]], presenting as continuous [[vibration]].<ref name="pmid24598790">{{cite journal |vauthors=Iglesias Escalera G, Diaz-Delgado Peñas R, Carrasco Marina ML, Maraña Perez A, Ialeggio D |title=[A vertebral arteriovenous fistula diagnosed by auscultation] |language=Spanish; Castilian |journal=An Pediatr (Barc) |volume=82 |issue=1 |pages=e98–e101 |date=January 2015 |pmid=24598790 |doi=10.1016/j.anpedi.2013.12.011 |url=}}</ref> | ||
*Imaging is the modality of choice to effectively diagnose an arteriovenous fistula (AVF) and it includes: | *[[Imaging]] is the [[modality]] of choice to effectively [[diagnose]] an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] and it includes: | ||
:*Duplex ultrasound<ref name="pmid25623503">{{cite journal |vauthors=Soumer K, Benomrane S, Derbel B, Laribi J, Benmrad M, Elleuch N, Kalfat T, Khayati A |title=Popliteal pseudoaneurysm and arteriovenous fistula after acupuncture |journal=J Mal Vasc |volume=40 |issue=1 |pages=58–62 |date=February 2015 |pmid=25623503 |doi=10.1016/j.jmv.2014.11.001 |url=}}</ref><ref name="pmid26614386">{{cite journal |vauthors=Tsai LK, Yeh SJ, Tang SC, Hsieh YL, Chen YA, Liu HM, Jeng JS |title=Validity of Carotid Duplex Sonography in Screening for Intracranial Dural Arteriovenous Fistula among Patients with Pulsatile Tinnitus |journal=Ultrasound Med Biol |volume=42 |issue=2 |pages=407–12 |date=February 2016 |pmid=26614386 |doi=10.1016/j.ultrasmedbio.2015.10.013 |url=}}</ref> | :*[[Duplex ultrasound]]<ref name="pmid25623503">{{cite journal |vauthors=Soumer K, Benomrane S, Derbel B, Laribi J, Benmrad M, Elleuch N, Kalfat T, Khayati A |title=Popliteal pseudoaneurysm and arteriovenous fistula after acupuncture |journal=J Mal Vasc |volume=40 |issue=1 |pages=58–62 |date=February 2015 |pmid=25623503 |doi=10.1016/j.jmv.2014.11.001 |url=}}</ref><ref name="pmid26614386">{{cite journal |vauthors=Tsai LK, Yeh SJ, Tang SC, Hsieh YL, Chen YA, Liu HM, Jeng JS |title=Validity of Carotid Duplex Sonography in Screening for Intracranial Dural Arteriovenous Fistula among Patients with Pulsatile Tinnitus |journal=Ultrasound Med Biol |volume=42 |issue=2 |pages=407–12 |date=February 2016 |pmid=26614386 |doi=10.1016/j.ultrasmedbio.2015.10.013 |url=}}</ref> | ||
:*Computed tomography angiography (CTA)<ref name="pmid26614386">{{cite journal |vauthors=Tsai LK, Yeh SJ, Tang SC, Hsieh YL, Chen YA, Liu HM, Jeng JS |title=Validity of Carotid Duplex Sonography in Screening for Intracranial Dural Arteriovenous Fistula among Patients with Pulsatile Tinnitus |journal=Ultrasound Med Biol |volume=42 |issue=2 |pages=407–12 |date=February 2016 |pmid=26614386 |doi=10.1016/j.ultrasmedbio.2015.10.013 |url=}}</ref><ref name="pmid24975976">{{cite journal |vauthors=Macco S, van Werkum MH, van Leersum M, Alvarez Herrero L, Roos D |title=[A splenic arteriovenous fistula] |language=Dutch; Flemish |journal=Ned Tijdschr Geneeskd |volume=158 |issue= |pages=A7342 |date=2014 |pmid=24975976 |doi= |url=}}</ref><ref name="pmid24717642">{{cite journal |vauthors=Joshi D, Imam A |title=Volume rendered three-dimensional CT angiography for the diagnosis of arteriovenous fistula and pseudoaneurysm of the popliteal artery following knee arthroscopy |journal=BMJ Case Rep |volume=2014 |issue= |pages= |date=April 2014 |pmid=24717642 |pmc=3987242 |doi=10.1136/bcr-2014-204442 |url=}}</ref><ref name="pmid26615454">{{cite journal |vauthors=Lee JY, Jung C, Ihn YK, Kim DJ, Seong SO, Kwon BJ |title=Multidetector CT angiography in the diagnosis and classification of carotid-cavernous fistula |journal=Clin Radiol |volume=71 |issue=1 |pages=e64–71 |date=January 2016 |pmid=26615454 |doi=10.1016/j.crad.2015.10.018 |url=}}</ref><ref name="pmid24277857">{{cite journal |vauthors=Saboo SS, Juan YH, Belkin M, Sacks A, Khandelwal A, Steigner ML, Rybicki FJ |title=Multi-detector CT angiography in case of concomitant pseudoaneurysm and arteriovenous fistula of the lateral superior geniculate artery |journal=Postgrad Med J |volume=90 |issue=1060 |pages=118–9 |date=February 2014 |pmid=24277857 |doi=10.1136/postgradmedj-2013-132274 |url=}}</ref><ref name="pmid29188304">{{cite journal |vauthors=Lin YH, Wang YF, Liu HM, Lee CW, Chen YF, Hsieh HJ |title=Diagnostic accuracy of CTA and MRI/MRA in the evaluation of the cortical venous reflux in the intracranial dural arteriovenous fistula DAVF |journal=Neuroradiology |volume=60 |issue=1 |pages=7–15 |date=January 2018 |pmid=29188304 |doi=10.1007/s00234-017-1948-2 |url=}}</ref><ref name="pmid27185610">{{cite journal |vauthors=Lin YH, Lin HH, Liu HM, Lee CW, Chen YF |title=Diagnostic performance of CT and MRI on the detection of symptomatic intracranial dural arteriovenous fistula: a meta-analysis with indirect comparison |journal=Neuroradiology |volume=58 |issue=8 |pages=753–63 |date=August 2016 |pmid=27185610 |doi=10.1007/s00234-016-1696-8 |url=}}</ref> | :*[[Computed tomography angiography|Computed tomography angiography (CTA)]]<ref name="pmid26614386">{{cite journal |vauthors=Tsai LK, Yeh SJ, Tang SC, Hsieh YL, Chen YA, Liu HM, Jeng JS |title=Validity of Carotid Duplex Sonography in Screening for Intracranial Dural Arteriovenous Fistula among Patients with Pulsatile Tinnitus |journal=Ultrasound Med Biol |volume=42 |issue=2 |pages=407–12 |date=February 2016 |pmid=26614386 |doi=10.1016/j.ultrasmedbio.2015.10.013 |url=}}</ref><ref name="pmid24975976">{{cite journal |vauthors=Macco S, van Werkum MH, van Leersum M, Alvarez Herrero L, Roos D |title=[A splenic arteriovenous fistula] |language=Dutch; Flemish |journal=Ned Tijdschr Geneeskd |volume=158 |issue= |pages=A7342 |date=2014 |pmid=24975976 |doi= |url=}}</ref><ref name="pmid24717642">{{cite journal |vauthors=Joshi D, Imam A |title=Volume rendered three-dimensional CT angiography for the diagnosis of arteriovenous fistula and pseudoaneurysm of the popliteal artery following knee arthroscopy |journal=BMJ Case Rep |volume=2014 |issue= |pages= |date=April 2014 |pmid=24717642 |pmc=3987242 |doi=10.1136/bcr-2014-204442 |url=}}</ref><ref name="pmid26615454">{{cite journal |vauthors=Lee JY, Jung C, Ihn YK, Kim DJ, Seong SO, Kwon BJ |title=Multidetector CT angiography in the diagnosis and classification of carotid-cavernous fistula |journal=Clin Radiol |volume=71 |issue=1 |pages=e64–71 |date=January 2016 |pmid=26615454 |doi=10.1016/j.crad.2015.10.018 |url=}}</ref><ref name="pmid24277857">{{cite journal |vauthors=Saboo SS, Juan YH, Belkin M, Sacks A, Khandelwal A, Steigner ML, Rybicki FJ |title=Multi-detector CT angiography in case of concomitant pseudoaneurysm and arteriovenous fistula of the lateral superior geniculate artery |journal=Postgrad Med J |volume=90 |issue=1060 |pages=118–9 |date=February 2014 |pmid=24277857 |doi=10.1136/postgradmedj-2013-132274 |url=}}</ref><ref name="pmid29188304">{{cite journal |vauthors=Lin YH, Wang YF, Liu HM, Lee CW, Chen YF, Hsieh HJ |title=Diagnostic accuracy of CTA and MRI/MRA in the evaluation of the cortical venous reflux in the intracranial dural arteriovenous fistula DAVF |journal=Neuroradiology |volume=60 |issue=1 |pages=7–15 |date=January 2018 |pmid=29188304 |doi=10.1007/s00234-017-1948-2 |url=}}</ref><ref name="pmid27185610">{{cite journal |vauthors=Lin YH, Lin HH, Liu HM, Lee CW, Chen YF |title=Diagnostic performance of CT and MRI on the detection of symptomatic intracranial dural arteriovenous fistula: a meta-analysis with indirect comparison |journal=Neuroradiology |volume=58 |issue=8 |pages=753–63 |date=August 2016 |pmid=27185610 |doi=10.1007/s00234-016-1696-8 |url=}}</ref> | ||
:*Magnetic resonance angiography (MRA)<ref name="pmid29188304">{{cite journal |vauthors=Lin YH, Wang YF, Liu HM, Lee CW, Chen YF, Hsieh HJ |title=Diagnostic accuracy of CTA and MRI/MRA in the evaluation of the cortical venous reflux in the intracranial dural arteriovenous fistula DAVF |journal=Neuroradiology |volume=60 |issue=1 |pages=7–15 |date=January 2018 |pmid=29188304 |doi=10.1007/s00234-017-1948-2 |url=}}</ref><ref name="pmid24591106">{{cite journal |vauthors=Condette-Auliac S, Boulin A, Roccatagliata L, Coskun O, Guieu S, Guedin P, Rodesch G |title=MRI and MRA of spinal cord arteriovenous shunts |journal=J Magn Reson Imaging |volume=40 |issue=6 |pages=1253–66 |date=December 2014 |pmid=24591106 |doi=10.1002/jmri.24591 |url=}}</ref><ref name="pmid29170838">{{cite journal |vauthors=Martinez M, Pergami P, Murnick J, Pearl MS |title=Embolization of a traumatic arteriovenous fistula between the middle meningeal artery and middle meningeal vein in a child with pulsatile tinnitus |journal=Childs Nerv Syst |volume=34 |issue=3 |pages=571–575 |date=March 2018 |pmid=29170838 |doi=10.1007/s00381-017-3665-x |url=}}</ref><ref name="pmid27185610">{{cite journal |vauthors=Lin YH, Lin HH, Liu HM, Lee CW, Chen YF |title=Diagnostic performance of CT and MRI on the detection of symptomatic intracranial dural arteriovenous fistula: a meta-analysis with indirect comparison |journal=Neuroradiology |volume=58 |issue=8 |pages=753–63 |date=August 2016 |pmid=27185610 |doi=10.1007/s00234-016-1696-8 |url=}}</ref> | :*[[Magnetic resonance angiography|Magnetic resonance angiography (MRA)]]<ref name="pmid29188304">{{cite journal |vauthors=Lin YH, Wang YF, Liu HM, Lee CW, Chen YF, Hsieh HJ |title=Diagnostic accuracy of CTA and MRI/MRA in the evaluation of the cortical venous reflux in the intracranial dural arteriovenous fistula DAVF |journal=Neuroradiology |volume=60 |issue=1 |pages=7–15 |date=January 2018 |pmid=29188304 |doi=10.1007/s00234-017-1948-2 |url=}}</ref><ref name="pmid24591106">{{cite journal |vauthors=Condette-Auliac S, Boulin A, Roccatagliata L, Coskun O, Guieu S, Guedin P, Rodesch G |title=MRI and MRA of spinal cord arteriovenous shunts |journal=J Magn Reson Imaging |volume=40 |issue=6 |pages=1253–66 |date=December 2014 |pmid=24591106 |doi=10.1002/jmri.24591 |url=}}</ref><ref name="pmid29170838">{{cite journal |vauthors=Martinez M, Pergami P, Murnick J, Pearl MS |title=Embolization of a traumatic arteriovenous fistula between the middle meningeal artery and middle meningeal vein in a child with pulsatile tinnitus |journal=Childs Nerv Syst |volume=34 |issue=3 |pages=571–575 |date=March 2018 |pmid=29170838 |doi=10.1007/s00381-017-3665-x |url=}}</ref><ref name="pmid27185610">{{cite journal |vauthors=Lin YH, Lin HH, Liu HM, Lee CW, Chen YF |title=Diagnostic performance of CT and MRI on the detection of symptomatic intracranial dural arteriovenous fistula: a meta-analysis with indirect comparison |journal=Neuroradiology |volume=58 |issue=8 |pages=753–63 |date=August 2016 |pmid=27185610 |doi=10.1007/s00234-016-1696-8 |url=}}</ref> | ||
===Symptoms=== | ===Symptoms=== | ||
*An arteriovenous fistula (AVF) can be asymptomatic. | *An [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] can be [[asymptomatic]]. | ||
*Symptoms may include: | *[[Symptom|Symptoms]], when present, may include: | ||
:*Low blood pressure and dizziness<ref name="pmid21725657">{{cite journal |vauthors=Mise N, Uchida L, Tanaka M, Tanaka S, Nakajima H, Sugimoto T |title=Acute systemic hypotension after arteriovenous fistula construction in a patient with severe aortic stenosis |journal=Clin. Exp. Nephrol. |volume=15 |issue=5 |pages=788–790 |date=October 2011 |pmid=21725657 |doi=10.1007/s10157-011-0484-3 |url=}}</ref> | :*[[Low blood pressure]] and [[dizziness]]<ref name="pmid21725657">{{cite journal |vauthors=Mise N, Uchida L, Tanaka M, Tanaka S, Nakajima H, Sugimoto T |title=Acute systemic hypotension after arteriovenous fistula construction in a patient with severe aortic stenosis |journal=Clin. Exp. Nephrol. |volume=15 |issue=5 |pages=788–790 |date=October 2011 |pmid=21725657 |doi=10.1007/s10157-011-0484-3 |url=}}</ref> | ||
:*Swelling in limbs/body<ref name="pmid27184364">{{cite journal |vauthors=Karuppiah Viswanathan AM, Irodi A, Keshava SN, Aneez J, Karthik G |title=Arteriolymphatic Fistula: An Unusual Cause of Spontaneous Swelling in the Left Supraclavicular Region |journal=Cardiovasc Intervent Radiol |volume=39 |issue=9 |pages=1347–51 |date=September 2016 |pmid=27184364 |doi=10.1007/s00270-016-1348-8 |url=}}</ref><ref name="pmid28779783">{{cite journal |vauthors=Kamyar MM, Saeed Modaghegh MH, Kazemzadeh G |title=Limb complaints after autogenous arteriovenous fistula creation in chronic hemodialysis patients |journal=Semin Vasc Surg |volume=29 |issue=4 |pages=172–177 |date=December 2016 |pmid=28779783 |doi=10.1053/j.semvascsurg.2016.11.002 |url=}}</ref><ref name="pmid15874939">{{cite journal |vauthors=Huang W, Villavicencio JL, Rich NM |title=Delayed treatment and late complications of a traumatic arteriovenous fistula |journal=J. Vasc. Surg. |volume=41 |issue=4 |pages=715–7 |date=April 2005 |pmid=15874939 |doi=10.1016/j.jvs.2005.01.049 |url=}}</ref> | :*[[Swelling]] in [[limbs]]/[[body]]<ref name="pmid27184364">{{cite journal |vauthors=Karuppiah Viswanathan AM, Irodi A, Keshava SN, Aneez J, Karthik G |title=Arteriolymphatic Fistula: An Unusual Cause of Spontaneous Swelling in the Left Supraclavicular Region |journal=Cardiovasc Intervent Radiol |volume=39 |issue=9 |pages=1347–51 |date=September 2016 |pmid=27184364 |doi=10.1007/s00270-016-1348-8 |url=}}</ref><ref name="pmid28779783">{{cite journal |vauthors=Kamyar MM, Saeed Modaghegh MH, Kazemzadeh G |title=Limb complaints after autogenous arteriovenous fistula creation in chronic hemodialysis patients |journal=Semin Vasc Surg |volume=29 |issue=4 |pages=172–177 |date=December 2016 |pmid=28779783 |doi=10.1053/j.semvascsurg.2016.11.002 |url=}}</ref><ref name="pmid15874939">{{cite journal |vauthors=Huang W, Villavicencio JL, Rich NM |title=Delayed treatment and late complications of a traumatic arteriovenous fistula |journal=J. Vasc. Surg. |volume=41 |issue=4 |pages=715–7 |date=April 2005 |pmid=15874939 |doi=10.1016/j.jvs.2005.01.049 |url=}}</ref> | ||
:*Pain at the acquired arteriovenous fistula (AVF) site<ref name="pmid28779783">{{cite journal |vauthors=Kamyar MM, Saeed Modaghegh MH, Kazemzadeh G |title=Limb complaints after autogenous arteriovenous fistula creation in chronic hemodialysis patients |journal=Semin Vasc Surg |volume=29 |issue=4 |pages=172–177 |date=December 2016 |pmid=28779783 |doi=10.1053/j.semvascsurg.2016.11.002 |url=}}</ref> | :*[[Pain]] at the [[acquired]] [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] site<ref name="pmid28779783">{{cite journal |vauthors=Kamyar MM, Saeed Modaghegh MH, Kazemzadeh G |title=Limb complaints after autogenous arteriovenous fistula creation in chronic hemodialysis patients |journal=Semin Vasc Surg |volume=29 |issue=4 |pages=172–177 |date=December 2016 |pmid=28779783 |doi=10.1053/j.semvascsurg.2016.11.002 |url=}}</ref> | ||
:*Dyspnea and fatigue<ref name="pmid25304908">{{cite journal |vauthors=Takahashi S, Katayama K, Tatsugawa T, Sueda T |title=A successful hybrid repair for vertebral arteriovenous fistula with extracranial vertebral artery aneurysm |journal=Ann Vasc Surg |volume=29 |issue=1 |pages=126.e5–8 |date=January 2015 |pmid=25304908 |doi=10.1016/j.avsg.2014.07.038 |url=}}</ref><ref name="pmid24501988">{{cite journal |vauthors=Opanasenko MS, Klymenko VI, Demus RS, Konik BM, Tereshkovych OV, Kalenychenko MI, Bychkovs'kyĭ VB, Obrems'ka OK, Levanda LI, Kononenko VA, Kshanovs'kyĭ OE, Mykytenko IIu |title=[Pulmonary arteriovenous fistulas] |language=Ukrainian |journal=Klin Khir |volume= |issue=11 |pages=41–6 |date=November 2013 |pmid=24501988 |doi= |url=}}</ref><ref name="pmid12197607">{{cite journal |vauthors=Ozeki S, Utsunomiya T, Kishi T, Tokushima T, Tsuji S, Matsuo S, Natsuaki M, Ito T, Yano K |title=Coronary arteriovenous fistula presenting as chronic pericardial effusion |journal=Circ. J. |volume=66 |issue=8 |pages=779–82 |date=August 2002 |pmid=12197607 |doi= |url=}}</ref><ref name="pmid24959370">{{cite journal |vauthors=Porter J, Al-Jarrah Q, Richardson S |title=A case of femoral arteriovenous fistula causing high-output cardiac failure, originally misdiagnosed as chronic fatigue syndrome |journal=Case Rep Vasc Med |volume=2014 |issue= |pages=510429 |date=2014 |pmid=24959370 |pmc=4055063 |doi=10.1155/2014/510429 |url=}}</ref><ref name="pmid8678732">{{cite journal |vauthors=Fourcade L, Vahdat B, Panagides D, Yvorra S, Bonnet JL, Bory M |title=[Pulmonary arteriovenous fistula. A rare cause of dyspnea and cyanosis in an adult] |language=French |journal=Arch Mal Coeur Vaiss |volume=89 |issue=1 |pages=103–6 |date=January 1996 |pmid=8678732 |doi= |url=}}</ref> | :*[[Dyspnea]] and [[fatigue]]<ref name="pmid25304908">{{cite journal |vauthors=Takahashi S, Katayama K, Tatsugawa T, Sueda T |title=A successful hybrid repair for vertebral arteriovenous fistula with extracranial vertebral artery aneurysm |journal=Ann Vasc Surg |volume=29 |issue=1 |pages=126.e5–8 |date=January 2015 |pmid=25304908 |doi=10.1016/j.avsg.2014.07.038 |url=}}</ref><ref name="pmid24501988">{{cite journal |vauthors=Opanasenko MS, Klymenko VI, Demus RS, Konik BM, Tereshkovych OV, Kalenychenko MI, Bychkovs'kyĭ VB, Obrems'ka OK, Levanda LI, Kononenko VA, Kshanovs'kyĭ OE, Mykytenko IIu |title=[Pulmonary arteriovenous fistulas] |language=Ukrainian |journal=Klin Khir |volume= |issue=11 |pages=41–6 |date=November 2013 |pmid=24501988 |doi= |url=}}</ref><ref name="pmid12197607">{{cite journal |vauthors=Ozeki S, Utsunomiya T, Kishi T, Tokushima T, Tsuji S, Matsuo S, Natsuaki M, Ito T, Yano K |title=Coronary arteriovenous fistula presenting as chronic pericardial effusion |journal=Circ. J. |volume=66 |issue=8 |pages=779–82 |date=August 2002 |pmid=12197607 |doi= |url=}}</ref><ref name="pmid24959370">{{cite journal |vauthors=Porter J, Al-Jarrah Q, Richardson S |title=A case of femoral arteriovenous fistula causing high-output cardiac failure, originally misdiagnosed as chronic fatigue syndrome |journal=Case Rep Vasc Med |volume=2014 |issue= |pages=510429 |date=2014 |pmid=24959370 |pmc=4055063 |doi=10.1155/2014/510429 |url=}}</ref><ref name="pmid8678732">{{cite journal |vauthors=Fourcade L, Vahdat B, Panagides D, Yvorra S, Bonnet JL, Bory M |title=[Pulmonary arteriovenous fistula. A rare cause of dyspnea and cyanosis in an adult] |language=French |journal=Arch Mal Coeur Vaiss |volume=89 |issue=1 |pages=103–6 |date=January 1996 |pmid=8678732 |doi= |url=}}</ref> | ||
:*Skin changes<ref name="pmid15874939">{{cite journal |vauthors=Huang W, Villavicencio JL, Rich NM |title=Delayed treatment and late complications of a traumatic arteriovenous fistula |journal=J. Vasc. Surg. |volume=41 |issue=4 |pages=715–7 |date=April 2005 |pmid=15874939 |doi=10.1016/j.jvs.2005.01.049 |url=}}</ref><ref name="pmid17222301">{{cite journal |vauthors=Roberts H, Curnow PA |title=Unilateral limited scleroderma-like changes following formation of an arteriovenous fistula |journal=Australas. J. Dermatol. |volume=48 |issue=1 |pages=37–9 |date=February 2007 |pmid=17222301 |doi=10.1111/j.1440-0960.2007.00325.x |url=}}</ref> | :*[[Skin changes]]<ref name="pmid15874939">{{cite journal |vauthors=Huang W, Villavicencio JL, Rich NM |title=Delayed treatment and late complications of a traumatic arteriovenous fistula |journal=J. Vasc. Surg. |volume=41 |issue=4 |pages=715–7 |date=April 2005 |pmid=15874939 |doi=10.1016/j.jvs.2005.01.049 |url=}}</ref><ref name="pmid17222301">{{cite journal |vauthors=Roberts H, Curnow PA |title=Unilateral limited scleroderma-like changes following formation of an arteriovenous fistula |journal=Australas. J. Dermatol. |volume=48 |issue=1 |pages=37–9 |date=February 2007 |pmid=17222301 |doi=10.1111/j.1440-0960.2007.00325.x |url=}}</ref> | ||
:*Palpable thrill<ref name="pmid15874939">{{cite journal |vauthors=Huang W, Villavicencio JL, Rich NM |title=Delayed treatment and late complications of a traumatic arteriovenous fistula |journal=J. Vasc. Surg. |volume=41 |issue=4 |pages=715–7 |date=April 2005 |pmid=15874939 |doi=10.1016/j.jvs.2005.01.049 |url=}}</ref><ref name="pmid25569414">{{cite journal |vauthors=Kim JH, Yoon SM, Choi HJ |title=Iatrogenic arteriovenous fistula of the superficial temporal artery after reduction malarplasty |journal=J Craniofac Surg |volume=26 |issue=1 |pages=e50–1 |date=January 2015 |pmid=25569414 |doi=10.1097/SCS.0000000000001312 |url=}}</ref> | :*[[Palpable thrill]]<ref name="pmid15874939">{{cite journal |vauthors=Huang W, Villavicencio JL, Rich NM |title=Delayed treatment and late complications of a traumatic arteriovenous fistula |journal=J. Vasc. Surg. |volume=41 |issue=4 |pages=715–7 |date=April 2005 |pmid=15874939 |doi=10.1016/j.jvs.2005.01.049 |url=}}</ref><ref name="pmid25569414">{{cite journal |vauthors=Kim JH, Yoon SM, Choi HJ |title=Iatrogenic arteriovenous fistula of the superficial temporal artery after reduction malarplasty |journal=J Craniofac Surg |volume=26 |issue=1 |pages=e50–1 |date=January 2015 |pmid=25569414 |doi=10.1097/SCS.0000000000001312 |url=}}</ref> | ||
:*Melena<ref name="pmid22563184">{{cite journal |vauthors=Chen B, Tang CW, Zhang CL, Cao JW, Wei B, Li X |title=Melena-associated regional portal hypertension caused by splenic arteriovenous fistula |journal=World J. Gastroenterol. |volume=18 |issue=16 |pages=1996–8 |date=April 2012 |pmid=22563184 |pmc=3337579 |doi=10.3748/wjg.v18.i16.1996 |url=}}</ref> | :*[[Melena]]<ref name="pmid22563184">{{cite journal |vauthors=Chen B, Tang CW, Zhang CL, Cao JW, Wei B, Li X |title=Melena-associated regional portal hypertension caused by splenic arteriovenous fistula |journal=World J. Gastroenterol. |volume=18 |issue=16 |pages=1996–8 |date=April 2012 |pmid=22563184 |pmc=3337579 |doi=10.3748/wjg.v18.i16.1996 |url=}}</ref> | ||
:*Hemoptysis<ref name="pmid25712408">{{cite journal |vauthors=Dokumcu Z, Ozcan C, Alper H, Erdener A |title=Pulmonary arteriovenous malformation in children |journal=Pediatr Int |volume=57 |issue=4 |pages=708–11 |date=August 2015 |pmid=25712408 |doi=10.1111/ped.12564 |url=}}</ref><ref name="pmid25226754">{{cite journal |vauthors=Majeed FA, Ghumman AQ, Chatha SS |title=Pulmonary arteriovenous malformation (PAVM): rare cause of hemoptysis |journal=J Ayub Med Coll Abbottabad |volume=25 |issue=3-4 |pages=100–2 |date=2013 |pmid=25226754 |doi= |url=}}</ref><ref name="pmid23381321">{{cite journal |vauthors=Hu Y, Zhong Q, Li Z, Chen J, Shen C, Song Y |title=An occult congenital fistula between the descending aorta and the left pulmonary vein in an adult presenting with recurrent episodes of hemoptysis |journal=Chest |volume=143 |issue=2 |pages=549–553 |date=February 2013 |pmid=23381321 |doi=10.1378/chest.11-3229 |url=}}</ref> | :*[[Hemoptysis]]<ref name="pmid25712408">{{cite journal |vauthors=Dokumcu Z, Ozcan C, Alper H, Erdener A |title=Pulmonary arteriovenous malformation in children |journal=Pediatr Int |volume=57 |issue=4 |pages=708–11 |date=August 2015 |pmid=25712408 |doi=10.1111/ped.12564 |url=}}</ref><ref name="pmid25226754">{{cite journal |vauthors=Majeed FA, Ghumman AQ, Chatha SS |title=Pulmonary arteriovenous malformation (PAVM): rare cause of hemoptysis |journal=J Ayub Med Coll Abbottabad |volume=25 |issue=3-4 |pages=100–2 |date=2013 |pmid=25226754 |doi= |url=}}</ref><ref name="pmid23381321">{{cite journal |vauthors=Hu Y, Zhong Q, Li Z, Chen J, Shen C, Song Y |title=An occult congenital fistula between the descending aorta and the left pulmonary vein in an adult presenting with recurrent episodes of hemoptysis |journal=Chest |volume=143 |issue=2 |pages=549–553 |date=February 2013 |pmid=23381321 |doi=10.1378/chest.11-3229 |url=}}</ref> | ||
===Physical Examination=== | ===Physical Examination=== | ||
*Patients with an arteriovenous fistula (AVF) usually appear normal. | *[[Patient|Patients]] with an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] usually appear normal. | ||
*Physical examination may be remarkable for: | *[[Physical examination]] may be remarkable for: | ||
:*Increased size of the limb<ref name="pmid2917907">{{cite journal |vauthors=Parks AH, Guy BL, Rawlings CA, Constantino MJ |title=Lameness in a mare with signs of arteriovenous fistula |journal=J. Am. Vet. Med. Assoc. |volume=194 |issue=3 |pages=379–80 |date=February 1989 |pmid=2917907 |doi= |url=}}</ref> | :*Increased size of the [[limb]]<ref name="pmid2917907">{{cite journal |vauthors=Parks AH, Guy BL, Rawlings CA, Constantino MJ |title=Lameness in a mare with signs of arteriovenous fistula |journal=J. Am. Vet. Med. Assoc. |volume=194 |issue=3 |pages=379–80 |date=February 1989 |pmid=2917907 |doi= |url=}}</ref> | ||
:*Skin temperature and color alteration<ref name="pmid10405695">{{cite journal |vauthors=Swanson KL, Prakash UB, Stanson AW, Ketteridge D, Brezina R, Schramek S, Kazár J, Moroff G, Brandt KG, Anderson TR, Slotkin TA, Harrison LW, Auld DS, Vallee BL, Baghurst PA, Nichol LW, Kozuch O, Mayer V, Swanson KL, Prakash UB, Stanson AW, Schmoldt A, Benthe HF, Haberland G, Lambros C, Bacchi CJ, Moroff G, Brandt KG, Anderson TR, Slotkin TA, Harrison LW, Auld DS, Vallee BL |title=Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982-1997 |journal=Mayo Clin. Proc. |volume=74 |issue=7 |pages=671–80 |date=July 1999 |pmid=10405695 |doi=10.4065/74.7.671 |url=}}</ref> | :*[[Skin]] [[temperature]] and color alteration<ref name="pmid10405695">{{cite journal |vauthors=Swanson KL, Prakash UB, Stanson AW, Ketteridge D, Brezina R, Schramek S, Kazár J, Moroff G, Brandt KG, Anderson TR, Slotkin TA, Harrison LW, Auld DS, Vallee BL, Baghurst PA, Nichol LW, Kozuch O, Mayer V, Swanson KL, Prakash UB, Stanson AW, Schmoldt A, Benthe HF, Haberland G, Lambros C, Bacchi CJ, Moroff G, Brandt KG, Anderson TR, Slotkin TA, Harrison LW, Auld DS, Vallee BL |title=Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982-1997 |journal=Mayo Clin. Proc. |volume=74 |issue=7 |pages=671–80 |date=July 1999 |pmid=10405695 |doi=10.4065/74.7.671 |url=}}</ref> | ||
:*Prominent veins<ref name="pmid2917907">{{cite journal |vauthors=Parks AH, Guy BL, Rawlings CA, Constantino MJ |title=Lameness in a mare with signs of arteriovenous fistula |journal=J. Am. Vet. Med. Assoc. |volume=194 |issue=3 |pages=379–80 |date=February 1989 |pmid=2917907 |doi= |url=}}</ref> | :*Prominent [[Vein|veins]]<ref name="pmid2917907">{{cite journal |vauthors=Parks AH, Guy BL, Rawlings CA, Constantino MJ |title=Lameness in a mare with signs of arteriovenous fistula |journal=J. Am. Vet. Med. Assoc. |volume=194 |issue=3 |pages=379–80 |date=February 1989 |pmid=2917907 |doi= |url=}}</ref> | ||
:*Audible murmur<ref name="pmid26711922">{{cite journal |vauthors=Asada D, Itoi T, Hamaoka K |title=Asymptomatic spinal arteriovenous fistula presenting only as continuous murmur |journal=Pediatr Int |volume=57 |issue=6 |pages=1208–10 |date=December 2015 |pmid=26711922 |doi=10.1111/ped.12716 |url=}}</ref> | :*Audible [[murmur]]<ref name="pmid26711922">{{cite journal |vauthors=Asada D, Itoi T, Hamaoka K |title=Asymptomatic spinal arteriovenous fistula presenting only as continuous murmur |journal=Pediatr Int |volume=57 |issue=6 |pages=1208–10 |date=December 2015 |pmid=26711922 |doi=10.1111/ped.12716 |url=}}</ref> | ||
:*Palpable thrill<ref name="pmid2917907">{{cite journal |vauthors=Parks AH, Guy BL, Rawlings CA, Constantino MJ |title=Lameness in a mare with signs of arteriovenous fistula |journal=J. Am. Vet. Med. Assoc. |volume=194 |issue=3 |pages=379–80 |date=February 1989 |pmid=2917907 |doi= |url=}}</ref> | :*[[Palpable thrill]]<ref name="pmid2917907">{{cite journal |vauthors=Parks AH, Guy BL, Rawlings CA, Constantino MJ |title=Lameness in a mare with signs of arteriovenous fistula |journal=J. Am. Vet. Med. Assoc. |volume=194 |issue=3 |pages=379–80 |date=February 1989 |pmid=2917907 |doi= |url=}}</ref> | ||
:*Nicoladoni-Branham sign<ref name="pmid13564989">{{cite journal |vauthors=BURCHELL HB |title=Observations on bradycardia produced by occlusion of an artery proximal to an arteriovenous fistula (Nicoladoni-Branham sign) |journal=Med. Clin. North Am. |volume=42 |issue=4 |pages=1029–35 |date=July 1958 |pmid=13564989 |doi= |url=}}</ref><ref name="pmid2917907">{{cite journal |vauthors=Parks AH, Guy BL, Rawlings CA, Constantino MJ |title=Lameness in a mare with signs of arteriovenous fistula |journal=J. Am. Vet. Med. Assoc. |volume=194 |issue=3 |pages=379–80 |date=February 1989 |pmid=2917907 |doi= |url=}}</ref><ref name="pmid6742939">{{cite journal |vauthors=Dallo L, Pastrana C, Rodríguez G, Medina Mora O, Barragán R, Bialostozky D |title=[Acquired systemic arteriovenous fistulas. Experience of 33 cases] |language=Spanish; Castilian |journal=Arch Inst Cardiol Mex |volume=54 |issue=2 |pages=159–66 |date=1984 |pmid=6742939 |doi= |url=}}</ref> | :*Nicoladoni-Branham sign (a decrease in pulse and increase in blood pressure that immediately follows the sudden occlusion of an [[Arteriovenous fistulae|arteriovenous fistula [AVF])]]<ref name="pmid13564989">{{cite journal |vauthors=BURCHELL HB |title=Observations on bradycardia produced by occlusion of an artery proximal to an arteriovenous fistula (Nicoladoni-Branham sign) |journal=Med. Clin. North Am. |volume=42 |issue=4 |pages=1029–35 |date=July 1958 |pmid=13564989 |doi= |url=}}</ref><ref name="pmid2917907">{{cite journal |vauthors=Parks AH, Guy BL, Rawlings CA, Constantino MJ |title=Lameness in a mare with signs of arteriovenous fistula |journal=J. Am. Vet. Med. Assoc. |volume=194 |issue=3 |pages=379–80 |date=February 1989 |pmid=2917907 |doi= |url=}}</ref><ref name="pmid6742939">{{cite journal |vauthors=Dallo L, Pastrana C, Rodríguez G, Medina Mora O, Barragán R, Bialostozky D |title=[Acquired systemic arteriovenous fistulas. Experience of 33 cases] |language=Spanish; Castilian |journal=Arch Inst Cardiol Mex |volume=54 |issue=2 |pages=159–66 |date=1984 |pmid=6742939 |doi= |url=}}</ref> | ||
:*Mass effect<ref name="pmid16630920">{{cite journal |vauthors=Iwamuro Y, Nakahara I, Higashi T, Iwaasa M, Watanabe Y, Hirata E, Tsunetoshi K, Taha M |title=Tentorial dural arteriovenous fistula presenting symptoms due to mass effect on the dilated draining vein: case report |journal=Surg Neurol |volume=65 |issue=5 |pages=511–5 |date=May 2006 |pmid=16630920 |doi=10.1016/j.surneu.2005.07.076 |url=}}</ref><ref name="pmid26444959">{{cite journal |vauthors=Ernst GL, Carlson AP |title=Transverse Sinus Dural Arteriovenous Fistula Presenting with Acute Hydrocephalus from Cerebellar Venous Engorgement Resolving with Endovascular Treatment |journal=J Neurol Surg A Cent Eur Neurosurg |volume=77 |issue=6 |pages=538–542 |date=November 2016 |pmid=26444959 |doi=10.1055/s-0035-1563558 |url=}}</ref> | :*[[Mass effect]]<ref name="pmid16630920">{{cite journal |vauthors=Iwamuro Y, Nakahara I, Higashi T, Iwaasa M, Watanabe Y, Hirata E, Tsunetoshi K, Taha M |title=Tentorial dural arteriovenous fistula presenting symptoms due to mass effect on the dilated draining vein: case report |journal=Surg Neurol |volume=65 |issue=5 |pages=511–5 |date=May 2006 |pmid=16630920 |doi=10.1016/j.surneu.2005.07.076 |url=}}</ref><ref name="pmid26444959">{{cite journal |vauthors=Ernst GL, Carlson AP |title=Transverse Sinus Dural Arteriovenous Fistula Presenting with Acute Hydrocephalus from Cerebellar Venous Engorgement Resolving with Endovascular Treatment |journal=J Neurol Surg A Cent Eur Neurosurg |volume=77 |issue=6 |pages=538–542 |date=November 2016 |pmid=26444959 |doi=10.1055/s-0035-1563558 |url=}}</ref> | ||
:*Pain and numbness<ref name="pmid28186472">{{cite journal |vauthors=Nasr DM, Brinjikji W, Clarke MJ, Lanzino G |title=Clinical presentation and treatment outcomes of spinal epidural arteriovenous fistulas |journal=J Neurosurg Spine |volume=26 |issue=5 |pages=613–620 |date=May 2017 |pmid=28186472 |doi=10.3171/2016.9.SPINE16618 |url=}}</ref> | :*[[Pain]] and [[numbness]]<ref name="pmid28186472">{{cite journal |vauthors=Nasr DM, Brinjikji W, Clarke MJ, Lanzino G |title=Clinical presentation and treatment outcomes of spinal epidural arteriovenous fistulas |journal=J Neurosurg Spine |volume=26 |issue=5 |pages=613–620 |date=May 2017 |pmid=28186472 |doi=10.3171/2016.9.SPINE16618 |url=}}</ref> | ||
:*Extremity weakness | :*Extremity [[weakness]] | ||
:*Cyanosis<ref name="pmid10405695">{{cite journal |vauthors=Swanson KL, Prakash UB, Stanson AW |title=Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982-1997 |journal=Mayo Clin. Proc. |volume=74 |issue=7 |pages=671–80 |date=July 1999 |pmid=10405695 |doi=10.4065/74.7.671 |url=}}</ref><ref name="pmid8678732">{{cite journal |vauthors=Fourcade L, Vahdat B, Panagides D, Yvorra S, Bonnet JL, Bory M |title=[Pulmonary arteriovenous fistula. A rare cause of dyspnea and cyanosis in an adult] |language=French |journal=Arch Mal Coeur Vaiss |volume=89 |issue=1 |pages=103–6 |date=January 1996 |pmid=8678732 |doi= |url=}}</ref> | :*[[Cyanosis]]<ref name="pmid10405695">{{cite journal |vauthors=Swanson KL, Prakash UB, Stanson AW |title=Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982-1997 |journal=Mayo Clin. Proc. |volume=74 |issue=7 |pages=671–80 |date=July 1999 |pmid=10405695 |doi=10.4065/74.7.671 |url=}}</ref><ref name="pmid8678732">{{cite journal |vauthors=Fourcade L, Vahdat B, Panagides D, Yvorra S, Bonnet JL, Bory M |title=[Pulmonary arteriovenous fistula. A rare cause of dyspnea and cyanosis in an adult] |language=French |journal=Arch Mal Coeur Vaiss |volume=89 |issue=1 |pages=103–6 |date=January 1996 |pmid=8678732 |doi= |url=}}</ref> | ||
:*Clubbing<ref name="pmid10405695">{{cite journal |vauthors=Swanson KL, Prakash UB, Stanson AW |title=Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982-1997 |journal=Mayo Clin. Proc. |volume=74 |issue=7 |pages=671–80 |date=July 1999 |pmid=10405695 |doi=10.4065/74.7.671 |url=}}</ref> | :*[[Clubbing]]<ref name="pmid10405695">{{cite journal |vauthors=Swanson KL, Prakash UB, Stanson AW |title=Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982-1997 |journal=Mayo Clin. Proc. |volume=74 |issue=7 |pages=671–80 |date=July 1999 |pmid=10405695 |doi=10.4065/74.7.671 |url=}}</ref> | ||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
*Laboratory findings associated with an arteriovenous fistula (AVF) can include the following: | *[[Laboratory]] findings associated with an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] can include the following: | ||
:*Polycythemia<ref name="pmid10405695">{{cite journal |vauthors=Swanson KL, Prakash UB, Stanson AW |title=Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982-1997 |journal=Mayo Clin. Proc. |volume=74 |issue=7 |pages=671–80 |date=July 1999 |pmid=10405695 |doi=10.4065/74.7.671 |url=}}</ref> | :*[[Polycythemia]]<ref name="pmid10405695">{{cite journal |vauthors=Swanson KL, Prakash UB, Stanson AW |title=Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982-1997 |journal=Mayo Clin. Proc. |volume=74 |issue=7 |pages=671–80 |date=July 1999 |pmid=10405695 |doi=10.4065/74.7.671 |url=}}</ref> | ||
:*Decreased arterial PO2 | :*Decreased [[arterial]] PO2 | ||
:*Decreased oxygen saturation<ref name="pmid25827966">{{cite journal |vauthors=Modaghegh MH, Roudsari B, Hafezi S |title=Digital pressure and oxygen saturation measurements in the diagnosis of chronic hemodialysis access-induced distal ischemia |journal=J. Vasc. Surg. |volume=62 |issue=1 |pages=135–42 |date=July 2015 |pmid=25827966 |doi=10.1016/j.jvs.2015.02.024 |url=}}</ref> | :*Decreased [[oxygen saturation]]<ref name="pmid25827966">{{cite journal |vauthors=Modaghegh MH, Roudsari B, Hafezi S |title=Digital pressure and oxygen saturation measurements in the diagnosis of chronic hemodialysis access-induced distal ischemia |journal=J. Vasc. Surg. |volume=62 |issue=1 |pages=135–42 |date=July 2015 |pmid=25827966 |doi=10.1016/j.jvs.2015.02.024 |url=}}</ref> | ||
:*Increased venous oxygen content<ref name="pmid871003">{{cite journal |vauthors=Kwaan JH, McCart PM, Jones SA, Connolly JE |title=Aortocaval fistula detection using a Swan-Ganz catheter |journal=Surg Gynecol Obstet |volume=144 |issue=6 |pages=919–21 |date=June 1977 |pmid=871003 |doi= |url=}}</ref> | :*Increased [[venous]] [[oxygen]] content<ref name="pmid871003">{{cite journal |vauthors=Kwaan JH, McCart PM, Jones SA, Connolly JE |title=Aortocaval fistula detection using a Swan-Ganz catheter |journal=Surg Gynecol Obstet |volume=144 |issue=6 |pages=919–21 |date=June 1977 |pmid=871003 |doi= |url=}}</ref> | ||
:*Decreased platelets and fibrinogen in the case of large fistulae<ref name="pmid4690101">{{cite journal |vauthors=Rhodes GR, Cox CB, Silver D |title=Arteriovenous fistula and false aneurysm as the cause of consumption coagulopathy |journal=Surgery |volume=73 |issue=4 |pages=535–40 |date=April 1973 |pmid=4690101 |doi= |url=}}</ref> | :*Decreased [[Platelet|platelets]] and [[fibrinogen]] in the case of large [[Fistula|fistulae]]<ref name="pmid4690101">{{cite journal |vauthors=Rhodes GR, Cox CB, Silver D |title=Arteriovenous fistula and false aneurysm as the cause of consumption coagulopathy |journal=Surgery |volume=73 |issue=4 |pages=535–40 |date=April 1973 |pmid=4690101 |doi= |url=}}</ref> | ||
*Swan-Ganz catheter findings in pulmonary arteriovenous fistula (AVF) include decreased arterial oxygenation and shunting of cardiac output.<ref name="pmid620567">{{cite journal |vauthors=Harrow EM, Beach PM, Wise JR, Lynch C, Graham WG, Wight G |title=Pulmonary arteriovenous fistula. Preoperative evaluation with a Swan-Ganz catheter |journal=Chest |volume=73 |issue=1 |pages=92–4 |date=January 1978 |pmid=620567 |doi= |url=}}</ref> | *[[Swan-Ganz catheter]] findings in [[Pulmonary arteriovenous fistula|pulmonary arteriovenous fistula (AVF)]] include decreased [[arterial]] [[oxygenation]] and [[shunting]] of [[cardiac output]].<ref name="pmid620567">{{cite journal |vauthors=Harrow EM, Beach PM, Wise JR, Lynch C, Graham WG, Wight G |title=Pulmonary arteriovenous fistula. Preoperative evaluation with a Swan-Ganz catheter |journal=Chest |volume=73 |issue=1 |pages=92–4 |date=January 1978 |pmid=620567 |doi= |url=}}</ref> | ||
*Swan-Ganz catheter findings in aorto-caval fistula include higher vena caval pressure and higher than normal oxygen content.<ref name="pmid871003">{{cite journal |vauthors=Kwaan JH, McCart PM, Jones SA, Connolly JE |title=Aortocaval fistula detection using a Swan-Ganz catheter |journal=Surg Gynecol Obstet |volume=144 |issue=6 |pages=919–21 |date=June 1977 |pmid=871003 |doi= |url=}}</ref> | *[[Swan-Ganz catheter]] findings in [[Aorta|aorto]]-[[Vena cava|caval]] [[fistula]] include higher [[Vena cava|vena caval]] [[pressure]] and higher than normal [[oxygen]] content.<ref name="pmid871003">{{cite journal |vauthors=Kwaan JH, McCart PM, Jones SA, Connolly JE |title=Aortocaval fistula detection using a Swan-Ganz catheter |journal=Surg Gynecol Obstet |volume=144 |issue=6 |pages=919–21 |date=June 1977 |pmid=871003 |doi= |url=}}</ref> | ||
*Patients on hemodialysis suffering from occlusive and thrombotic events of the arteriovenous fistula (AVF) may exhibit significant increase of platelet surface glycoproteins GPIb and GPIIb/IIIa.<ref name="pmid8841843">{{cite journal |vauthors=Liani M, Salvati F, Tresca E, Di Paolo G, Vitacolonna L, Golato M, Velussi C |title=Arteriovenous fistula obstruction and expression of platelet receptors for von Willebrand factor and for fibrinogen (glycoproteins GPib and GPiib/iiia) in hemodialysis patients |journal=Int J Artif Organs |volume=19 |issue=8 |pages=451–4 |date=August 1996 |pmid=8841843 |doi= |url=}}</ref> | *[[Patient|Patients]] on [[hemodialysis]] suffering from [[Occlusion|occlusive]] and [[thrombotic]] events of the [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] may exhibit significant increase of [[platelet]] surface [[Glycoprotein|glycoproteins]] [[Glycoprotein Ib|GPIb]] and [[Glycoprotein IIb/IIIa|GPIIb/IIIa]].<ref name="pmid8841843">{{cite journal |vauthors=Liani M, Salvati F, Tresca E, Di Paolo G, Vitacolonna L, Golato M, Velussi C |title=Arteriovenous fistula obstruction and expression of platelet receptors for von Willebrand factor and for fibrinogen (glycoproteins GPib and GPiib/iiia) in hemodialysis patients |journal=Int J Artif Organs |volume=19 |issue=8 |pages=451–4 |date=August 1996 |pmid=8841843 |doi= |url=}}</ref> | ||
*Large fistulae can also present with laboratory findings of consumptive coagulopathy such as, low platelets, increased bleeding time, elevated prothrombin time (PT) and partial thromboplastin time (PTT), and signs of enhanced fibrinolysis.<ref name="pmid4690101">{{cite journal |vauthors=Rhodes GR, Cox CB, Silver D |title=Arteriovenous fistula and false aneurysm as the cause of consumption coagulopathy |journal=Surgery |volume=73 |issue=4 |pages=535–40 |date=April 1973 |pmid=4690101 |doi= |url=}}</ref><ref name="pmid8672026">{{cite journal |vauthors=Erdem Y, Haznedaroglu IC, Celik I, Yalcin AU, Yasavul U, Turgan C, Caglar S |title=Coagulation, fibrinolysis and fibrinolysis inhibitors in haemodialysis patients: contribution of arteriovenous fistula |journal=Nephrol. Dial. Transplant. |volume=11 |issue=7 |pages=1299–305 |date=July 1996 |pmid=8672026 |doi= |url=}}</ref> | *Large [[fistulae]] can also present with [[laboratory]] findings of [[consumptive coagulopathy]] such as, [[Thrombocytopenia|low platelets]], increased [[bleeding time]], elevated [[Prothrombin time|prothrombin time (PT)]] and [[Partial thromboplastin time|partial thromboplastin time (PTT)]], and signs of enhanced [[fibrinolysis]].<ref name="pmid4690101">{{cite journal |vauthors=Rhodes GR, Cox CB, Silver D |title=Arteriovenous fistula and false aneurysm as the cause of consumption coagulopathy |journal=Surgery |volume=73 |issue=4 |pages=535–40 |date=April 1973 |pmid=4690101 |doi= |url=}}</ref><ref name="pmid8672026">{{cite journal |vauthors=Erdem Y, Haznedaroglu IC, Celik I, Yalcin AU, Yasavul U, Turgan C, Caglar S |title=Coagulation, fibrinolysis and fibrinolysis inhibitors in haemodialysis patients: contribution of arteriovenous fistula |journal=Nephrol. Dial. Transplant. |volume=11 |issue=7 |pages=1299–305 |date=July 1996 |pmid=8672026 |doi= |url=}}</ref> | ||
===Imaging Findings=== | ===Imaging Findings=== | ||
*Computed tomography angiography (CTA) and magnetic resonance | *[[Computed tomography angiography|Computed tomography angiography (CTA)]] and [[Magnetic resonance angiography|magnetic resonance angiography (MRA)]] are the [[imaging]] modalities of choice for an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] with modest evidence that [[Computed tomography angiography|computed tomography angiography (CTA)]] is better than [[Magnetic resonance angiography|magnetic resonance angiography (MRA)]].<ref name="pmid29188304">{{cite journal |vauthors=Lin YH, Wang YF, Liu HM, Lee CW, Chen YF, Hsieh HJ |title=Diagnostic accuracy of CTA and MRI/MRA in the evaluation of the cortical venous reflux in the intracranial dural arteriovenous fistula DAVF |journal=Neuroradiology |volume=60 |issue=1 |pages=7–15 |date=January 2018 |pmid=29188304 |doi=10.1007/s00234-017-1948-2 |url=}}</ref> | ||
*On plain radiograph, an arteriovenous fistula (AVF) is characterized by a round or oval lobulated homogeneous mass and the identification of feeding and draining vessels can also | *On plain [[radiograph]], an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] is characterized by a round or oval lobulated [[homogeneous]] [[mass]] and the identification of feeding and draining [[vessels]] can also be possible.<ref name="pmid1461986">{{cite journal |vauthors=Uhl M, Richter GM, Kauffmann GW, Herb P, Tüngerthal S |title=[Pulmonary arteriovenous fistulas in Osler's disease] |language=German |journal=Radiologe |volume=32 |issue=11 |pages=562–7 |date=November 1992 |pmid=1461986 |doi= |url=}}</ref> | ||
*On ultrasound, an arteriovenous fistula (AVF) is characterized by a pseudoaneurysm, high flow velocity, increased diastolic arterial flow, abnormal arterial pulsitility in the vein, and enlargement of the downstream vein.<ref name="pmid24472357">{{cite journal |vauthors=Goksu E, Yuruktumen A, Kaya H |title=Traumatic pseudoaneurysm and arteriovenous fistula detected by bedside ultrasound |journal=J Emerg Med |volume=46 |issue=5 |pages=667–9 |date=May 2014 |pmid=24472357 |doi=10.1016/j.jemermed.2013.08.136 |url=}}</ref><ref name="pmid28073202">{{cite journal |vauthors=Galosi AB, Capretti C, Leone L, Tiroli M, Cantoro D, Polito M |title=Pseudoaneurysm with arteriovenous fistula of the prostate after pelvic trauma: Ultrasound imaging |journal=Arch Ital Urol Androl |volume=88 |issue=4 |pages=317–319 |date=December 2016 |pmid=28073202 |doi=10.4081/aiua.2016.4.317 |url=}}</ref><ref>{{cite book | last = Pellerito | first = John | title = Introduction to vascular ultrasonography | publisher = Saunders/Elsevier | location = Philadelphia, PA | year = 2012 | isbn = 143771417X }}</ref><ref name="pmid20489077">{{cite journal |vauthors=Venkatanarasimha N, Freeman S |title=Ultrasound features of arteriovenous fistula |journal=AJR Am J Roentgenol |volume=194 |issue=6 |pages=W540; author reply W543 |date=June 2010 |pmid=20489077 |doi=10.2214/AJR.09.3978 |url=}}</ref> | *On [[ultrasound]], an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] is characterized by a [[pseudoaneurysm]], high [[flow]] [[velocity]], increased [[diastolic]] [[arterial]] [[flow]], abnormal [[arterial]] [[Pulse|pulsitility]] in the [[vein]], and enlargement of the downstream [[vein]].<ref name="pmid24472357">{{cite journal |vauthors=Goksu E, Yuruktumen A, Kaya H |title=Traumatic pseudoaneurysm and arteriovenous fistula detected by bedside ultrasound |journal=J Emerg Med |volume=46 |issue=5 |pages=667–9 |date=May 2014 |pmid=24472357 |doi=10.1016/j.jemermed.2013.08.136 |url=}}</ref><ref name="pmid28073202">{{cite journal |vauthors=Galosi AB, Capretti C, Leone L, Tiroli M, Cantoro D, Polito M |title=Pseudoaneurysm with arteriovenous fistula of the prostate after pelvic trauma: Ultrasound imaging |journal=Arch Ital Urol Androl |volume=88 |issue=4 |pages=317–319 |date=December 2016 |pmid=28073202 |doi=10.4081/aiua.2016.4.317 |url=}}</ref><ref>{{cite book | last = Pellerito | first = John | title = Introduction to vascular ultrasonography | publisher = Saunders/Elsevier | location = Philadelphia, PA | year = 2012 | isbn = 143771417X }}</ref><ref name="pmid20489077">{{cite journal |vauthors=Venkatanarasimha N, Freeman S |title=Ultrasound features of arteriovenous fistula |journal=AJR Am J Roentgenol |volume=194 |issue=6 |pages=W540; author reply W543 |date=June 2010 |pmid=20489077 |doi=10.2214/AJR.09.3978 |url=}}</ref> | ||
*On computed tomography | *On [[Computed tomography angiography|computed tomography angiography (CTA)]] and [[Magnetic resonance angiography|magnetic resonance angiography (MRA)]], an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] is characterized by abnormal [[dilatation]] along with early and flow-related enhancements.<ref>{{cite book | last = Pellerito | first = John | title = Introduction to vascular ultrasonography | publisher = Saunders/Elsevier | location = Philadelphia, PA | year = 2012 | isbn = 143771417X }}</ref><ref name="pmid29188304">{{cite journal |vauthors=Lin YH, Wang YF, Liu HM, Lee CW, Chen YF, Hsieh HJ |title=Diagnostic accuracy of CTA and MRI/MRA in the evaluation of the cortical venous reflux in the intracranial dural arteriovenous fistula DAVF |journal=Neuroradiology |volume=60 |issue=1 |pages=7–15 |date=January 2018 |pmid=29188304 |doi=10.1007/s00234-017-1948-2 |url=}}</ref> | ||
*On digital subtraction arteriography (DSA), an arteriovenous fistula (AVF) is characterized by abnormal early filling of an adjacent vein in the region of the fistula.<ref>{{cite book | last = Pellerito | first = John | title = Introduction to vascular ultrasonography | publisher = Saunders/Elsevier | location = Philadelphia, PA | year = 2012 | isbn = 143771417X }}</ref> | *On digital subtraction arteriography (DSA), an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] is characterized by an abnormal early filling of an adjacent [[vein]] in the region of the [[fistula]].<ref>{{cite book | last = Pellerito | first = John | title = Introduction to vascular ultrasonography | publisher = Saunders/Elsevier | location = Philadelphia, PA | year = 2012 | isbn = 143771417X }}</ref> | ||
===Other Diagnostic Studies=== | ===Other Diagnostic Studies=== | ||
*An arteriovenous fistula (AVF) involving the heart and pulmonary vasculature in some cases, can also be diagnosed via echocardiography.<ref name="pmid23895668">{{cite journal |vauthors=Roomi AU, Kemaloglu Oz T, Williams SO, Nanda NC, Mehta KJ, Sungur A, McGiffin DC |title=Two- and three-dimensional transthoracic echocardiography in the assessment of acquired ascending aortic aneurysm to pulmonary artery fistula |journal=Echocardiography |volume=30 |issue=9 |pages=1107–10 |date=October 2013 |pmid=23895668 |doi=10.1111/echo.12330 |url=}}</ref><ref name="pmid24813063">{{cite journal |vauthors=Karam C, Sellier J, Mansencal N, Fagnou C, Blivet S, Chinet T, Lacombe P, Dubourg O |title=Reliability of contrast echocardiography to rule out pulmonary arteriovenous malformations and avoid CT irradiation in pediatric patients with hereditary hemorrhagic telangiectasia |journal=Echocardiography |volume=32 |issue=1 |pages=42–8 |date=January 2015 |pmid=24813063 |doi=10.1111/echo.12615 |url=}}</ref><ref name="pmid6721946">{{cite journal |vauthors=Miyatake K, Okamoto M, Kinoshita N, Fusejima K, Sakakibara H, Nimura Y |title=Doppler echocardiographic features of coronary arteriovenous fistula. Complementary roles of cross sectional echocardiography and the Doppler technique |journal=Br Heart J |volume=51 |issue=5 |pages=508–18 |date=May 1984 |pmid=6721946 |pmc=481541 |doi= |url=}}</ref> | *An [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] involving the [[heart]] and [[pulmonary vasculature]] in some cases, can also be [[Diagnose|diagnosed]] via [[echocardiography]].<ref name="pmid23895668">{{cite journal |vauthors=Roomi AU, Kemaloglu Oz T, Williams SO, Nanda NC, Mehta KJ, Sungur A, McGiffin DC |title=Two- and three-dimensional transthoracic echocardiography in the assessment of acquired ascending aortic aneurysm to pulmonary artery fistula |journal=Echocardiography |volume=30 |issue=9 |pages=1107–10 |date=October 2013 |pmid=23895668 |doi=10.1111/echo.12330 |url=}}</ref><ref name="pmid24813063">{{cite journal |vauthors=Karam C, Sellier J, Mansencal N, Fagnou C, Blivet S, Chinet T, Lacombe P, Dubourg O |title=Reliability of contrast echocardiography to rule out pulmonary arteriovenous malformations and avoid CT irradiation in pediatric patients with hereditary hemorrhagic telangiectasia |journal=Echocardiography |volume=32 |issue=1 |pages=42–8 |date=January 2015 |pmid=24813063 |doi=10.1111/echo.12615 |url=}}</ref><ref name="pmid6721946">{{cite journal |vauthors=Miyatake K, Okamoto M, Kinoshita N, Fusejima K, Sakakibara H, Nimura Y |title=Doppler echocardiographic features of coronary arteriovenous fistula. Complementary roles of cross sectional echocardiography and the Doppler technique |journal=Br Heart J |volume=51 |issue=5 |pages=508–18 |date=May 1984 |pmid=6721946 |pmc=481541 |doi= |url=}}</ref> | ||
*Findings on echocardiography may include | *Findings on the [[echocardiography]] may include dilated [[lumen]] and abnormal unidirectional continuous flow signals with broad [[velocity]] spectra<ref name="pmid6721946">{{cite journal |vauthors=Miyatake K, Okamoto M, Kinoshita N, Fusejima K, Sakakibara H, Nimura Y |title=Doppler echocardiographic features of coronary arteriovenous fistula. Complementary roles of cross sectional echocardiography and the Doppler technique |journal=Br Heart J |volume=51 |issue=5 |pages=508–18 |date=May 1984 |pmid=6721946 |pmc=481541 |doi= |url=}}</ref> | ||
*An aorto-caval fistula may also be diagnosed using Swan-Ganz catheter, demonstrating higher vena caval pressure and higher than normal oxygen content.<ref name="pmid871003">{{cite journal |vauthors=Kwaan JH, McCart PM, Jones SA, Connolly JE |title=Aortocaval fistula detection using a Swan-Ganz catheter |journal=Surg Gynecol Obstet |volume=144 |issue=6 |pages=919–21 |date=June 1977 |pmid=871003 |doi= |url=}}</ref> | *An [[Aorta|aorto]]-[[Vena cava|caval]] [[fistula]] may also be [[Diagnose|diagnosed]] using [[Swan-Ganz catheter]], demonstrating higher [[Vena cava|vena caval]] [[pressure]] and higher than normal [[oxygen]] content.<ref name="pmid871003">{{cite journal |vauthors=Kwaan JH, McCart PM, Jones SA, Connolly JE |title=Aortocaval fistula detection using a Swan-Ganz catheter |journal=Surg Gynecol Obstet |volume=144 |issue=6 |pages=919–21 |date=June 1977 |pmid=871003 |doi= |url=}}</ref> | ||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
*There is no medical treatment for an arteriovenous fistula (AVF). | *There is no [[medical treatment]] for an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]]. | ||
*Iatrogenic arteriovenous fistulae, presenting only as pain, can resolve after a trial of compression and observation.<ref name="pmid25404936">{{cite journal |vauthors=Miller RJ, MacRae JM, Mustata S |title=Conservative management of an iatrogenic arteriovenous fistula |journal=Nephron Extra |volume=4 |issue=3 |pages=155–8 |date=September 2014 |pmid=25404936 |pmc=4224231 |doi=10.1159/000366451 |url=}}</ref><ref name="pmid25404936">{{cite journal |vauthors=Miller RJ, MacRae JM, Mustata S |title=Conservative management of an iatrogenic arteriovenous fistula |journal=Nephron Extra |volume=4 |issue=3 |pages=155–8 |date=September 2014 |pmid=25404936 |pmc=4224231 |doi=10.1159/000366451 |url=}}</ref> | *[[Iatrogenic]] [[arteriovenous fistulae]], presenting only as [[pain]], can resolve after a trial of compression and [[observation]].<ref name="pmid25404936">{{cite journal |vauthors=Miller RJ, MacRae JM, Mustata S |title=Conservative management of an iatrogenic arteriovenous fistula |journal=Nephron Extra |volume=4 |issue=3 |pages=155–8 |date=September 2014 |pmid=25404936 |pmc=4224231 |doi=10.1159/000366451 |url=}}</ref><ref name="pmid25404936">{{cite journal |vauthors=Miller RJ, MacRae JM, Mustata S |title=Conservative management of an iatrogenic arteriovenous fistula |journal=Nephron Extra |volume=4 |issue=3 |pages=155–8 |date=September 2014 |pmid=25404936 |pmc=4224231 |doi=10.1159/000366451 |url=}}</ref> | ||
*Asymptomatic fistulae can resolve spontaneously and most lesions can be monitored after detection especially if the size of the lesion is small and they do not cause adverse effects.<ref name="pmid22107860">{{cite journal |vauthors=Paul AR, Colby GP, Huang J, Tamargo RJ, Coon AL |title=Selection of treatment modalities or observation of dural arteriovenous fistulas |journal=Neurosurg. Clin. N. Am. |volume=23 |issue=1 |pages=77–85 |date=January 2012 |pmid=22107860 |doi=10.1016/j.nec.2011.09.004 |url=}}</ref> | *[[Asymptomatic]] [[Fistula|fistulae]] can resolve spontaneously and most [[Lesion|lesions]] can be monitored after detection especially if the size of the [[lesion]] is small and they do not cause [[adverse effects]].<ref name="pmid22107860">{{cite journal |vauthors=Paul AR, Colby GP, Huang J, Tamargo RJ, Coon AL |title=Selection of treatment modalities or observation of dural arteriovenous fistulas |journal=Neurosurg. Clin. N. Am. |volume=23 |issue=1 |pages=77–85 |date=January 2012 |pmid=22107860 |doi=10.1016/j.nec.2011.09.004 |url=}}</ref> | ||
*Conservative management has been tried with a successful outcome in the case of an arteriovenous fistula (AVF) as a complication of vascular catheterization.<ref name="pmid25404936">{{cite journal |vauthors=Miller RJ, MacRae JM, Mustata S |title=Conservative management of an iatrogenic arteriovenous fistula |journal=Nephron Extra |volume=4 |issue=3 |pages=155–8 |date=September 2014 |pmid=25404936 |pmc=4224231 |doi=10.1159/000366451 |url=}}</ref> | *Conservative management has been tried with a successful outcome in the case of an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] as a [[complication]] of [[vascular]] [[catheterization]].<ref name="pmid25404936">{{cite journal |vauthors=Miller RJ, MacRae JM, Mustata S |title=Conservative management of an iatrogenic arteriovenous fistula |journal=Nephron Extra |volume=4 |issue=3 |pages=155–8 |date=September 2014 |pmid=25404936 |pmc=4224231 |doi=10.1159/000366451 |url=}}</ref> | ||
===Surgery=== | ===Surgery=== | ||
*Surgery is the mainstay of therapy for an arteriovenous fistula (AVF). | *[[Surgery]] is the mainstay of therapy for an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]]. | ||
*Endovascular embolization is the most common approach to the treatment of an arteriovenous fistula (AVF), where a catheter is inserted into an artery and, guided by fluoroscopic or x-ray imaging, contrast is injected to visualize the vasculature followed by the injection of an embolization material (such as, particles, liquid embolics, embolization glue, detachable balloons, vascular plugs, and coils) into the exact location where the artery and the vein meet.<ref name="pmid27601322">{{cite journal |vauthors=Niimi Y |title=Endovascular treatment of pediatric intracranial arteriovenous shunt |journal=Pediatr Int |volume=59 |issue=3 |pages=247–257 |date=March 2017 |pmid=27601322 |doi=10.1111/ped.13159 |url=}}</ref><ref name="pmid27729606">{{cite journal |vauthors=Yokoyama R, Iihoshi S, Miyata K, Toyama K, Komatsu K, Wanibuchi M, Mikuni N |title=[Pediatric Iatrogenic Vertebral Arteriovenous Fistula Successfully Treated with Endovascular Treatment:A Case Report] |language=Japanese |journal=No Shinkei Geka |volume=44 |issue=10 |pages=857–861 |date=October 2016 |pmid=27729606 |doi=10.11477/mf.1436203390 |url=}}</ref><ref name="pmid28242409">{{cite journal |vauthors=Varghese K, Adhyapak SM |title=Stent Migration during Endovascular Treatment of Traumatic Arteriovenous Fistula following Lumbar Spine Surgery |journal=Ann Vasc Surg |volume=41 |issue= |pages=281.e1–281.e5 |date=May 2017 |pmid=28242409 |doi=10.1016/j.avsg.2016.09.032 |url=}}</ref><ref name="pmid24156861">{{cite journal |vauthors=Chaudhary N, Pandey AS, Gemmete JJ |title=Endovascular treatment of adult spinal arteriovenous lesions |journal=Neuroimaging Clin. N. Am. |volume=23 |issue=4 |pages=729–47 |date=November 2013 |pmid=24156861 |doi=10.1016/j.nic.2013.03.017 |url=}}</ref><ref name="pmid27015132">{{cite journal |vauthors=Bagherpour AN, Rodriguez GJ, Moorthy C, Trier TT, Maud A |title=Combined surgical and endovascular treatment of complex high-flow conus medullaris arteriovenous fistula associated with Parkes Weber syndrome: case report |journal=J Neurosurg Spine |volume=25 |issue=2 |pages=234–8 |date=August 2016 |pmid=27015132 |doi=10.3171/2016.1.SPINE151156 |url=}}</ref><ref name="pmid22850502">{{cite journal |vauthors=Teramoto S, Oishi H, Yoshida K, Yamamoto M, Ohara Y, Arai H |title=Paravertebral arteriovenous fistula treated by endovascular coil embolization |journal=Neurol. Med. Chir. (Tokyo) |volume=52 |issue=7 |pages=510–2 |date=2012 |pmid=22850502 |doi= |url=}}</ref><ref name="pmid28552142">{{cite journal |vauthors=Brown PA, Zomorodi AR, Gonzalez LF |title=Endovascular management of spinal dural arteriovenous fistulas |journal=Handb Clin Neurol |volume=143 |issue= |pages=199–213 |date=2017 |pmid=28552142 |doi=10.1016/B978-0-444-63640-9.00019-9 |url=}}</ref> | *[[Endovascular]] [[embolization]] is the most common approach to the treatment of an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]], where a catheter is inserted into an [[artery]] and, guided by [[Fluoroscopy|fluoroscopic]] or [[x-ray]] [[imaging]], [[contrast]] is [[injected]] to visualize the [[vasculature]] followed by the [[injection]] of an [[embolization]] material (such as, particles, liquid embolics, [[embolization]] glue, detachable balloons, [[vascular]] plugs, and coils) into the exact location where the [[artery]] and the [[vein]] meet.<ref name="pmid27601322">{{cite journal |vauthors=Niimi Y |title=Endovascular treatment of pediatric intracranial arteriovenous shunt |journal=Pediatr Int |volume=59 |issue=3 |pages=247–257 |date=March 2017 |pmid=27601322 |doi=10.1111/ped.13159 |url=}}</ref><ref name="pmid27729606">{{cite journal |vauthors=Yokoyama R, Iihoshi S, Miyata K, Toyama K, Komatsu K, Wanibuchi M, Mikuni N |title=[Pediatric Iatrogenic Vertebral Arteriovenous Fistula Successfully Treated with Endovascular Treatment:A Case Report] |language=Japanese |journal=No Shinkei Geka |volume=44 |issue=10 |pages=857–861 |date=October 2016 |pmid=27729606 |doi=10.11477/mf.1436203390 |url=}}</ref><ref name="pmid28242409">{{cite journal |vauthors=Varghese K, Adhyapak SM |title=Stent Migration during Endovascular Treatment of Traumatic Arteriovenous Fistula following Lumbar Spine Surgery |journal=Ann Vasc Surg |volume=41 |issue= |pages=281.e1–281.e5 |date=May 2017 |pmid=28242409 |doi=10.1016/j.avsg.2016.09.032 |url=}}</ref><ref name="pmid24156861">{{cite journal |vauthors=Chaudhary N, Pandey AS, Gemmete JJ |title=Endovascular treatment of adult spinal arteriovenous lesions |journal=Neuroimaging Clin. N. Am. |volume=23 |issue=4 |pages=729–47 |date=November 2013 |pmid=24156861 |doi=10.1016/j.nic.2013.03.017 |url=}}</ref><ref name="pmid27015132">{{cite journal |vauthors=Bagherpour AN, Rodriguez GJ, Moorthy C, Trier TT, Maud A |title=Combined surgical and endovascular treatment of complex high-flow conus medullaris arteriovenous fistula associated with Parkes Weber syndrome: case report |journal=J Neurosurg Spine |volume=25 |issue=2 |pages=234–8 |date=August 2016 |pmid=27015132 |doi=10.3171/2016.1.SPINE151156 |url=}}</ref><ref name="pmid22850502">{{cite journal |vauthors=Teramoto S, Oishi H, Yoshida K, Yamamoto M, Ohara Y, Arai H |title=Paravertebral arteriovenous fistula treated by endovascular coil embolization |journal=Neurol. Med. Chir. (Tokyo) |volume=52 |issue=7 |pages=510–2 |date=2012 |pmid=22850502 |doi= |url=}}</ref><ref name="pmid28552142">{{cite journal |vauthors=Brown PA, Zomorodi AR, Gonzalez LF |title=Endovascular management of spinal dural arteriovenous fistulas |journal=Handb Clin Neurol |volume=143 |issue= |pages=199–213 |date=2017 |pmid=28552142 |doi=10.1016/B978-0-444-63640-9.00019-9 |url=}}</ref> | ||
*Microsurgery, with or without endovascular embolization, is the most appropriate treatment for dural, brain, or spinal arteriovenous fistulae, where a titanium clip is placed to cut off the connection between the artery and the vein.<ref name="pmid27015132">{{cite journal |vauthors=Bagherpour AN, Rodriguez GJ, Moorthy C, Trier TT, Maud A |title=Combined surgical and endovascular treatment of complex high-flow conus medullaris arteriovenous fistula associated with Parkes Weber syndrome: case report |journal=J Neurosurg Spine |volume=25 |issue=2 |pages=234–8 |date=August 2016 |pmid=27015132 |doi=10.3171/2016.1.SPINE151156 |url=}}</ref><ref name="pmid28684369">{{cite journal |vauthors=Li J, Li G, Bian L, Hong T, Yu J, Zhang H, Ling F |title=Concomitant Lumbosacral Perimedullary Arteriovenous Fistula and Spinal Dural Arteriovenous Fistula |journal=World Neurosurg |volume=105 |issue= |pages=1041.e7–1041.e14 |date=September 2017 |pmid=28684369 |doi=10.1016/j.wneu.2017.06.149 |url=}}</ref><ref name="pmid25175574">{{cite journal |vauthors=Caplan JM, Groves M, Jusue-Torres I, Kim JE, Liauw J, Bydon A, Tamargo RJ |title=Microsurgical obliteration of a thoracic spinal perimedullary arteriovenous fistula |journal=Neurosurg Focus |volume=37 Suppl 2 |issue= |pages=Video 13 |date=September 2014 |pmid=25175574 |doi=10.3171/2014.V3.FOCUS14376 |url=}}</ref><ref name="pmid24093576">{{cite journal |vauthors=Yen CP, Lanzino G, Sheehan JP |title=Stereotactic radiosurgery of intracranial dural arteriovenous fistulas |journal=Neurosurg. Clin. N. Am. |volume=24 |issue=4 |pages=591–6 |date=October 2013 |pmid=24093576 |doi=10.1016/j.nec.2013.05.008 |url=}}</ref> | *[[Microsurgery]], with or without [[endovascular]] [[embolization]], is the most appropriate treatment for [[Dura|dural]], [[brain]], or [[Spinal cord|spinal]] [[arteriovenous fistulae]], where a [[titanium]] clip is placed to cut off the connection between the [[artery]] and the [[vein]].<ref name="pmid27015132">{{cite journal |vauthors=Bagherpour AN, Rodriguez GJ, Moorthy C, Trier TT, Maud A |title=Combined surgical and endovascular treatment of complex high-flow conus medullaris arteriovenous fistula associated with Parkes Weber syndrome: case report |journal=J Neurosurg Spine |volume=25 |issue=2 |pages=234–8 |date=August 2016 |pmid=27015132 |doi=10.3171/2016.1.SPINE151156 |url=}}</ref><ref name="pmid28684369">{{cite journal |vauthors=Li J, Li G, Bian L, Hong T, Yu J, Zhang H, Ling F |title=Concomitant Lumbosacral Perimedullary Arteriovenous Fistula and Spinal Dural Arteriovenous Fistula |journal=World Neurosurg |volume=105 |issue= |pages=1041.e7–1041.e14 |date=September 2017 |pmid=28684369 |doi=10.1016/j.wneu.2017.06.149 |url=}}</ref><ref name="pmid25175574">{{cite journal |vauthors=Caplan JM, Groves M, Jusue-Torres I, Kim JE, Liauw J, Bydon A, Tamargo RJ |title=Microsurgical obliteration of a thoracic spinal perimedullary arteriovenous fistula |journal=Neurosurg Focus |volume=37 Suppl 2 |issue= |pages=Video 13 |date=September 2014 |pmid=25175574 |doi=10.3171/2014.V3.FOCUS14376 |url=}}</ref><ref name="pmid24093576">{{cite journal |vauthors=Yen CP, Lanzino G, Sheehan JP |title=Stereotactic radiosurgery of intracranial dural arteriovenous fistulas |journal=Neurosurg. Clin. N. Am. |volume=24 |issue=4 |pages=591–6 |date=October 2013 |pmid=24093576 |doi=10.1016/j.nec.2013.05.008 |url=}}</ref> | ||
*Stereotactic radiosurgery | *[[Stereotactic radiosurgery]] is the treatment of choice to successfully obliterate an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] with low [[complication]] rates and hence preferred over [[endovascular]] [[embolization]] and [[microsurgery]] in the case of an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]] close to important [[brain]] structures.<ref name="pmid25479123">{{cite journal |vauthors=Chen CJ, Lee CC, Ding D, Starke RM, Chivukula S, Yen CP, Moosa S, Xu Z, Pan DH, Sheehan JP |title=Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review |journal=J. Neurosurg. |volume=122 |issue=2 |pages=353–62 |date=February 2015 |pmid=25479123 |doi=10.3171/2014.10.JNS14871 |url=}}</ref><ref name="pmid24093576">{{cite journal |vauthors=Yen CP, Lanzino G, Sheehan JP |title=Stereotactic radiosurgery of intracranial dural arteriovenous fistulas |journal=Neurosurg. Clin. N. Am. |volume=24 |issue=4 |pages=591–6 |date=October 2013 |pmid=24093576 |doi=10.1016/j.nec.2013.05.008 |url=}}</ref><ref name="pmid28465265">{{cite journal |vauthors=Park SH, Park KS, Kang DH, Hwang JH, Hwang SK |title=Stereotactic Radiosurgery for Dural Carotid Cavernous Sinus Fistulas |journal=World Neurosurg |volume=106 |issue= |pages=836–843 |date=October 2017 |pmid=28465265 |doi=10.1016/j.wneu.2017.04.143 |url=}}</ref><ref name="pmid27446527">{{cite journal |vauthors=Sung KS, Song YJ, Kim KU |title=Novalis Stereotactic Radiosurgery for Spinal Dural Arteriovenous Fistula |journal=J Korean Neurosurg Soc |volume=59 |issue=4 |pages=420–4 |date=July 2016 |pmid=27446527 |pmc=4954894 |doi=10.3340/jkns.2016.59.4.420 |url=}}</ref><ref name="pmid28803169">{{cite journal |vauthors=Tonetti DA, Gross BA, Jankowitz BT, Atcheson KM, Kano H, Monaco EA, Niranjan A, Lunsford LD |title=Stereotactic Radiosurgery for Dural Arteriovenous Fistulas without Cortical Venous Reflux |journal=World Neurosurg |volume=107 |issue= |pages=371–375 |date=November 2017 |pmid=28803169 |doi=10.1016/j.wneu.2017.07.170 |url=}}</ref> | ||
*Open surgical repair<ref name="pmid23072669">{{cite journal |vauthors=Brightwell RE, Pegna V, Boyne N |title=Aortocaval fistula: current management strategies |journal=ANZ J Surg |volume=83 |issue=1-2 |pages=31–5 |date=January 2013 |pmid=23072669 |doi=10.1111/j.1445-2197.2012.06294.x |url=}}</ref><ref name="pmid27151579">{{cite journal |vauthors=Lee CH |title=Stent graft repair of iatrogenic femoral arteriovenous fistula with acute bleeding after hemodialysis catheter insertion |journal=Hemodial Int |volume=20 |issue=4 |pages=497–500 |date=October 2016 |pmid=27151579 |doi=10.1111/hdi.12431 |url=}}</ref><ref name="pmid25873833">{{cite journal |vauthors=Ostras O, Kurkevych A, Bohuta L, Yalynska T, Raad T, Lewin M, Yemets I |title=Prenatal diagnosis of left pulmonary artery-to-pulmonary vein fistula and its successful surgical repair in a neonate |journal=Tex Heart Inst J |volume=42 |issue=2 |pages=169–71 |date=April 2015 |pmid=25873833 |pmc=4382888 |doi=10.14503/THIJ-13-3960 |url=}}</ref><ref name="pmid25798368">{{cite journal |vauthors=Roth P, Heiss C, Koshty A, Niemann B, Boening A |title=Posttraumatic arteriovenous fistula of the distal posterior tibial artery as cause of delayed wound healing in an unrecognized arterial injury |journal=Thorac Cardiovasc Surg Rep |volume=3 |issue=1 |pages=67–70 |date=December 2014 |pmid=25798368 |pmc=4360614 |doi=10.1055/s-0033-1363167 |url=}}</ref><ref name="pmid25304908">{{cite journal |vauthors=Takahashi S, Katayama K, Tatsugawa T, Sueda T |title=A successful hybrid repair for vertebral arteriovenous fistula with extracranial vertebral artery aneurysm |journal=Ann Vasc Surg |volume=29 |issue=1 |pages=126.e5–8 |date=January 2015 |pmid=25304908 |doi=10.1016/j.avsg.2014.07.038 |url=}}</ref><ref name="pmid30084789">{{cite journal |vauthors=Kızıltan HT |title=A Review of the Exclusion Technique as a Mode of Surgical Repair in the Treatment of Aortoiliac Aneurysms with Spontaneous Arteriovenous Fistulas |journal=Heart Surg Forum |volume=21 |issue=4 |pages=E326–E329 |date=July 2018 |pmid=30084789 |doi=10.1532/hsf.1939 |url=}}</ref> | *Open surgical repair<ref name="pmid23072669">{{cite journal |vauthors=Brightwell RE, Pegna V, Boyne N |title=Aortocaval fistula: current management strategies |journal=ANZ J Surg |volume=83 |issue=1-2 |pages=31–5 |date=January 2013 |pmid=23072669 |doi=10.1111/j.1445-2197.2012.06294.x |url=}}</ref><ref name="pmid27151579">{{cite journal |vauthors=Lee CH |title=Stent graft repair of iatrogenic femoral arteriovenous fistula with acute bleeding after hemodialysis catheter insertion |journal=Hemodial Int |volume=20 |issue=4 |pages=497–500 |date=October 2016 |pmid=27151579 |doi=10.1111/hdi.12431 |url=}}</ref><ref name="pmid25873833">{{cite journal |vauthors=Ostras O, Kurkevych A, Bohuta L, Yalynska T, Raad T, Lewin M, Yemets I |title=Prenatal diagnosis of left pulmonary artery-to-pulmonary vein fistula and its successful surgical repair in a neonate |journal=Tex Heart Inst J |volume=42 |issue=2 |pages=169–71 |date=April 2015 |pmid=25873833 |pmc=4382888 |doi=10.14503/THIJ-13-3960 |url=}}</ref><ref name="pmid25798368">{{cite journal |vauthors=Roth P, Heiss C, Koshty A, Niemann B, Boening A |title=Posttraumatic arteriovenous fistula of the distal posterior tibial artery as cause of delayed wound healing in an unrecognized arterial injury |journal=Thorac Cardiovasc Surg Rep |volume=3 |issue=1 |pages=67–70 |date=December 2014 |pmid=25798368 |pmc=4360614 |doi=10.1055/s-0033-1363167 |url=}}</ref><ref name="pmid25304908">{{cite journal |vauthors=Takahashi S, Katayama K, Tatsugawa T, Sueda T |title=A successful hybrid repair for vertebral arteriovenous fistula with extracranial vertebral artery aneurysm |journal=Ann Vasc Surg |volume=29 |issue=1 |pages=126.e5–8 |date=January 2015 |pmid=25304908 |doi=10.1016/j.avsg.2014.07.038 |url=}}</ref><ref name="pmid30084789">{{cite journal |vauthors=Kızıltan HT |title=A Review of the Exclusion Technique as a Mode of Surgical Repair in the Treatment of Aortoiliac Aneurysms with Spontaneous Arteriovenous Fistulas |journal=Heart Surg Forum |volume=21 |issue=4 |pages=E326–E329 |date=July 2018 |pmid=30084789 |doi=10.1532/hsf.1939 |url=}}</ref> | ||
===Prevention=== | ===Prevention=== | ||
*There are no specific primary prevention measures available for an arteriovenous fistula. | *There are no specific [[primary prevention]] measures available for an [[Arteriovenous fistulae|arteriovenous fistula (AVF)]]. | ||
*The acquired type, caused by trauma, can be prevented by avoiding trauma and also using caution while performing vascular access | *The [[acquired]] type, caused by [[trauma]], can be prevented by avoiding [[trauma]] and also using caution while performing [[Procedure|procedures]] involving [[vascular]] access. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
<div class="references-small"><references /></div> | <div class="references-small"> | ||
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Latest revision as of 16:17, 7 November 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]
Overview
An arteriovenous fistula (AVF) is an abnormal connection or passageway between an artery and a vein. It may be congenital, surgically created for hemodialysis treatment, or acquired due to a pathologic process, such as trauma or erosion of an arterial aneurysm. These communications can occur at any point in the vascular system; varying in size, length, location, and number.
Historical Perspective
- Arteriovenous fistula (AVF) was first discovered by William Hunter, in 1758, during a venipuncture with accidental piercing of the artery.[1][2][3][4]
- Congenital arteriovenous fistula (AVF) of the coronary arteries, a rare cardiac anomaly, was first described by Krause W. Uber, in 1865.[5][6][7]
Classification
- Arteriovenous fistula (AVF) can be classified into:
- Spontaneous, which can be further subdivided into cirsoid/congenital and idiopathic/aneurysmal.
- Acquired, which can be the result of a trauma or part of treatment for an underlying disorder.[3][8][9][10]
Pathophysiology
- The abnormal communication causes shunting of blood from high-pressure arterial side to the low-pressure venous side.
- An arteriovenous fistula (AVF) involving a major artery such as the abdominal aorta can lead to a large decrease in peripheral resistance, which in turn causes the heart to increase cardiac output in order to maintain proper blood flow to all tissues.
- The physical manifestations of this would be a relatively normal systolic blood pressure with a decreased diastolic blood pressure resulting in a wide (large) pulse pressure.
- Large arteriovenous fistulae (AVF) can lead to congestive heart failure associated with increased activity of vasoconstrictor neurohormonal systems, the renin-angiotensin, sympathetic nervous system, endothelin system, and Arginine vasopressin.[11]
- The increased activity of vasoconstrictor neurohormonal systems is in concurrence with compensatory activation of the vasodilating systems, the atrial natriuretic peptide (ANP) and nitric oxide (NO).
- A fistula can progress to an aneurysm, usually in the setting of a trauma, carrying a risk of rupture and necessitating surgical intervention.[12]
- The malformation can result in hemorrhage and the risk is significantly higher with small size malformation because of the significantly higher feeding artery pressures.[13]
Clinical Features
- In the case of a coronary arteriovenous fistula (AVF), patients can be asymptomatic or can present with:
- Systemic hypotension[16]
- Fistulae involving the spinal vasculature can present with neurologic symptoms of the lower extremities which may include weakness and sensory disturbance.[17]
- Acquired arteriovenous fistula (AVF) can result in digital clubbing.[18]
- Patients on hemodialysis with arteriovenous fistula (AVF) can develop pseudo-Kaposi's sarcoma.[19]
- Abdominal arteriovenous fistulae can present with:
- Lower extremity edema with cyanosis
- Pulsatile varicose veins
- Scrotal edema[20]
- Ilio-iliac arteriovenous fistula (AVF) presents with progressive abdominal distention, dyspnea, and edema of the leg, which makes it difficult to distinguish from deep venous thrombosis (DVT) and can lead to a delay in the diagnosis.[21]
- Tentorial dural arteriovenous fistula (AVF) can rarely manifest as trigeminal neuralgia.[22]
Differentiating Arteriovenous Fistula (AVF) from other Conditions
- It is important to differentiate an arteriovenous fistula (AVF) from other conditions that cause a hyperdynamic circulation such as:
- An ilio-iliac arteriovenous fistula (AVF) can lead to a misdiagnosis of deep venous thrombosis (DVT)[21]
Epidemiology and Demographics
- In a Scottish population-based study, the incidence of dural arteriovenous fistulae in adults was 0.16 per 100 000 per year.[29][30]
- In an Olmsted County, Minnesota-based study, the incidence and prevalence of dural arteriovenous fistulae from 1965-1992 are as follows:
- From 1965-1992, the incidence was estimated to be 1.84 cases per 100,000 individuals.
- From 1985-1992, the incidence was estimated to be 2.75 cases per 100,000 individuals.
- On January 1, 1990, the prevalence of identified cases was 19.0 per 100,000 individuals.[31]
Age
- Individuals of all age groups may acquire the condition.
- Congenital arteriovenous fistula (AVF) is present at birth and may manifest early or later in life.
Gender
- Arteriovenous fistula (AVF) is observed in both men and women equally.
Race
- There is no racial predilection for an arteriovenous fistula (AVF).
Risk Factors
- Common risk factors for the development of an arteriovenous fistula (AVF):
Natural History, Complications and Prognosis
- Patients can remain asymptomatic or can present with symptoms depending on the involved vasculature.
- Early clinical features include hypotension with hypoperfusion, skin changes, and can progress to include cardiac manifestations.
- If left untreated, a large arteriovenous fistula (AVF) can lead to compensated/decompensated heart failure.[52][53][54][55][56]
- Complications of an arteriovenous fistula (AVF) include:
- High-output compensated heart failure
- Decompensated heart failure
- Aneurysm formation[57][58][12][59][60][61][62][63]
- Hemorrhage[64][65][66][67][68]
- Portal hypertension[64]
- Venous stasis and thrombosis[69][70][71][72][73][74][75]
- Venous stenosis[76][77][78][79][80]
- Intracranial hypertension[81][82][83][84]
- Infective endocarditis[50][85][56][86][87]
- Ischemic heart disease and myocardial infarction[88][89][90][91][92][56]
- Cardiac arrhythmias[56]
- Paradoxical embolism (causing stroke and pulmonary embolism)[93][94][95][96][97][98][99][100][101][102][103]
- Angiosarcoma (at the arteriovenous fistula site for hemodialysis)[104][105][25][106][107][108][109][110][111]
- Pseudo-Kaposi's sarcoma[19][112][113][114][115][115]
- Steal phenomenon[116][117][118][119][120]
- Leiomyosarcoma[26][121][122]
- Prognosis of an arteriovenous fistula (AVF) is dependent on the system involved with many congenital fistulae undergoing regression and large fistulae may progress to cardiac decompensation and death.
Diagnosis
Diagnostic Criteria
- An arteriovenous fistula (AVF) can be detected by a stethoscope and can present with a machinery-like murmur.[123][124][17][125]
- A more superficial fistula can also be detected by palpation, presenting as continuous vibration.[126]
- Imaging is the modality of choice to effectively diagnose an arteriovenous fistula (AVF) and it includes:
Symptoms
- An arteriovenous fistula (AVF) can be asymptomatic.
- Symptoms, when present, may include:
Physical Examination
- Patients with an arteriovenous fistula (AVF) usually appear normal.
- Physical examination may be remarkable for:
- Increased size of the limb[149]
- Skin temperature and color alteration[150]
- Prominent veins[149]
- Audible murmur[17]
- Palpable thrill[149]
- Nicoladoni-Branham sign (a decrease in pulse and increase in blood pressure that immediately follows the sudden occlusion of an arteriovenous fistula [AVF])[151][149][152]
- Mass effect[153][154]
- Pain and numbness[155]
- Extremity weakness
- Cyanosis[150][143]
- Clubbing[150]
Laboratory Findings
- Laboratory findings associated with an arteriovenous fistula (AVF) can include the following:
- Polycythemia[150]
- Decreased arterial PO2
- Decreased oxygen saturation[156]
- Increased venous oxygen content[157]
- Decreased platelets and fibrinogen in the case of large fistulae[158]
- Swan-Ganz catheter findings in pulmonary arteriovenous fistula (AVF) include decreased arterial oxygenation and shunting of cardiac output.[159]
- Swan-Ganz catheter findings in aorto-caval fistula include higher vena caval pressure and higher than normal oxygen content.[157]
- Patients on hemodialysis suffering from occlusive and thrombotic events of the arteriovenous fistula (AVF) may exhibit significant increase of platelet surface glycoproteins GPIb and GPIIb/IIIa.[160]
- Large fistulae can also present with laboratory findings of consumptive coagulopathy such as, low platelets, increased bleeding time, elevated prothrombin time (PT) and partial thromboplastin time (PTT), and signs of enhanced fibrinolysis.[158][161]
Imaging Findings
- Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are the imaging modalities of choice for an arteriovenous fistula (AVF) with modest evidence that computed tomography angiography (CTA) is better than magnetic resonance angiography (MRA).[132]
- On plain radiograph, an arteriovenous fistula (AVF) is characterized by a round or oval lobulated homogeneous mass and the identification of feeding and draining vessels can also be possible.[162]
- On ultrasound, an arteriovenous fistula (AVF) is characterized by a pseudoaneurysm, high flow velocity, increased diastolic arterial flow, abnormal arterial pulsitility in the vein, and enlargement of the downstream vein.[163][164][165][166]
- On computed tomography angiography (CTA) and magnetic resonance angiography (MRA), an arteriovenous fistula (AVF) is characterized by abnormal dilatation along with early and flow-related enhancements.[167][132]
- On digital subtraction arteriography (DSA), an arteriovenous fistula (AVF) is characterized by an abnormal early filling of an adjacent vein in the region of the fistula.[168]
Other Diagnostic Studies
- An arteriovenous fistula (AVF) involving the heart and pulmonary vasculature in some cases, can also be diagnosed via echocardiography.[169][170][171]
- Findings on the echocardiography may include dilated lumen and abnormal unidirectional continuous flow signals with broad velocity spectra[171]
- An aorto-caval fistula may also be diagnosed using Swan-Ganz catheter, demonstrating higher vena caval pressure and higher than normal oxygen content.[157]
Treatment
Medical Therapy
- There is no medical treatment for an arteriovenous fistula (AVF).
- Iatrogenic arteriovenous fistulae, presenting only as pain, can resolve after a trial of compression and observation.[172][172]
- Asymptomatic fistulae can resolve spontaneously and most lesions can be monitored after detection especially if the size of the lesion is small and they do not cause adverse effects.[173]
- Conservative management has been tried with a successful outcome in the case of an arteriovenous fistula (AVF) as a complication of vascular catheterization.[172]
Surgery
- Surgery is the mainstay of therapy for an arteriovenous fistula (AVF).
- Endovascular embolization is the most common approach to the treatment of an arteriovenous fistula (AVF), where a catheter is inserted into an artery and, guided by fluoroscopic or x-ray imaging, contrast is injected to visualize the vasculature followed by the injection of an embolization material (such as, particles, liquid embolics, embolization glue, detachable balloons, vascular plugs, and coils) into the exact location where the artery and the vein meet.[174][175][176][177][178][179][180]
- Microsurgery, with or without endovascular embolization, is the most appropriate treatment for dural, brain, or spinal arteriovenous fistulae, where a titanium clip is placed to cut off the connection between the artery and the vein.[178][181][182][183]
- Stereotactic radiosurgery is the treatment of choice to successfully obliterate an arteriovenous fistula (AVF) with low complication rates and hence preferred over endovascular embolization and microsurgery in the case of an arteriovenous fistula (AVF) close to important brain structures.[184][183][185][186][187]
- Open surgical repair[188][189][190][191][139][192]
Prevention
- There are no specific primary prevention measures available for an arteriovenous fistula (AVF).
- The acquired type, caused by trauma, can be prevented by avoiding trauma and also using caution while performing procedures involving vascular access.
References
- ↑ Khodadad G (January 1973). "Arteriovenous malformations of the scalp". Ann. Surg. 177 (1): 79–85. PMC 1355509. PMID 4682507.
- ↑ Liu J, Shimada Y (2014). "A Case of Intractable Left Forearm Congenital Arteriovenous Fistula Ending with Amputation: Importance of New Medical Information Obtained via the Internet". J Rural Med. 9 (1): 37–9. doi:10.2185/jrm.2878. PMC 4310049. PMID 25650050.
- ↑ 3.0 3.1 Yater WM (January 1928). "ACQUIRED ARTERIOVENOUS FISTULA". Ann. Surg. 87 (1): 19–31. PMC 1398373. PMID 17865813.
- ↑ Olivecrona, Herbert (1957). Congenital arteriovenous aneurysms of the carotid and vertebral arterial systems. Berlin: Springer. ISBN 9783540022046.
- ↑ Albeyoglu S, Aldag M, Ciloglu U, Sargin M, Oz TK, Kutlu H, Dagsali S (2017). "Coronary Arteriovenous Fistulas in Adult Patients: Surgical Management and Outcomes". Braz J Cardiovasc Surg. 32 (1): 15–21. doi:10.21470/1678-9741-2017-0005. PMC 5382904. PMID 28423125.
- ↑ Lim WH, Kang SH, Jeon K, Cho I, Kim KH, Hwang SW, Kim HK, Sohn DW (September 2009). "Asymptomatic Right Coronary Artery-to-Pulmonary Artery Fistula Incidentally Detected by Transthoracic Echocardiography". J Cardiovasc Ultrasound. 17 (3): 106–9. doi:10.4250/jcu.2009.17.3.106. PMC 2889379. PMID 20661326.
- ↑ Jang SN, Her SH, Do KR, Kim JS, Yoon HJ, Lee JM, Jin SW (December 2008). "A case of congenital bilateral coronary-to-right ventricle fistula coexisting with variant angina". Korean J. Intern. Med. 23 (4): 216–8. doi:10.3904/kjim.2008.23.4.216. PMC 2687685. PMID 19119260.
- ↑ Robbs JV, Carrim AA, Kadwa AM, Mars M (September 1994). "Traumatic arteriovenous fistula: experience with 202 patients". Br J Surg. 81 (9): 1296–9. PMID 7953391.
- ↑ Nagpal K, Ahmed K, Cuschieri R (2008). "Diagnosis and management of acute traumatic arteriovenous fistula". Int. J. Angiol. 17 (4): 214–6. PMC 2728918. PMID 22477453.
- ↑ Laberge JM (December 2004). "Interventional management of renal transplant arteriovenous fistula". Semin Intervent Radiol. 21 (4): 239–46. doi:10.1055/s-2004-861558. PMC 3036239. PMID 21331135.
- ↑ Abassi ZA, Winaver J, Hoffman A (October 2003). "Large A-V fistula: pathophysiological consequences and therapeutic perspectives". Curr Vasc Pharmacol. 1 (3): 347–54. PMID 15320481.
- ↑ 12.0 12.1 12.2 Soumer K, Benomrane S, Derbel B, Laribi J, Benmrad M, Elleuch N, Kalfat T, Khayati A (February 2015). "Popliteal pseudoaneurysm and arteriovenous fistula after acupuncture". J Mal Vasc. 40 (1): 58–62. doi:10.1016/j.jmv.2014.11.001. PMID 25623503.
- ↑ Spetzler RF, Hargraves RW, McCormick PW, Zabramski JM, Flom RA, Zimmerman RS (June 1992). "Relationship of perfusion pressure and size to risk of hemorrhage from arteriovenous malformations". J. Neurosurg. 76 (6): 918–23. doi:10.3171/jns.1992.76.6.0918. PMID 1588424.
- ↑ Zamani H, Meragi M, Arabi Moghadam MY, Alizadeh B, Babazadeh K, Mokhtari-Esbuie F (2015). "Clinical presentation of coronary arteriovenous fistula according to age and anatomic orientation". Caspian J Intern Med. 6 (2): 108–12. PMC 4478461. PMID 26221510.
- ↑ Sapin P, Frantz E, Jain A, Nichols TC, Dehmer GJ (March 1990). "Coronary artery fistula: an abnormality affecting all age groups". Medicine (Baltimore). 69 (2): 101–13. PMID 2319939.
- ↑ 16.0 16.1 Mise N, Uchida L, Tanaka M, Tanaka S, Nakajima H, Sugimoto T (October 2011). "Acute systemic hypotension after arteriovenous fistula construction in a patient with severe aortic stenosis". Clin. Exp. Nephrol. 15 (5): 788–790. doi:10.1007/s10157-011-0484-3. PMID 21725657.
- ↑ 17.0 17.1 17.2 Asada D, Itoi T, Hamaoka K (December 2015). "Asymptomatic spinal arteriovenous fistula presenting only as continuous murmur". Pediatr Int. 57 (6): 1208–10. doi:10.1111/ped.12716. PMID 26711922.
- ↑ Leb DE, Sharma JK (July 1978). "Clubbing secondary to an arteriovenous fistula used for hemodialysis". JAMA. 240 (2): 142–3. PMID 660832.
- ↑ 19.0 19.1 Hwang SM, Lee SH, Ahn SK (December 1999). "Pincer nail deformity and pseudo-Kaposi's sarcoma: complications of an artificial arteriovenous fistula for haemodialysis". Br. J. Dermatol. 141 (6): 1129–32. PMID 10606867.
- ↑ Scruggs J, Bennett DD (June 2011). "Cutaneous manifestations of abdominal arteriovenous fistulas". Cutis. 87 (6): 284–6. PMID 21838084.
- ↑ 21.0 21.1 Li Y, Fu Q, Liu A, Zheng Z, Fan W, Zhu Z, Chen L, Dai W (November 2014). "[A case of iatrogenic ilio-iliac arteriovenous fistula initially misdiagnosed as deep venous thrombosis]". Zhong Nan Da Xue Xue Bao Yi Xue Ban (in Chinese). 39 (11): 1217–20. doi:10.11817/j.issn.1672-7347.2014.11.019. PMID 25432380.
- ↑ Lu X, Qin X, Ni L, Chen J, Xu F (November 2013). "Tentorial dural arteriovenous fistula manifesting as contralateral trigeminal neuralgia: resolution after transarterial Onyx embolization". BMJ Case Rep. 2013. doi:10.1136/bcr-2013-010984. PMC 3847479. PMID 24285803.
- ↑ Fernández-Rodriguez CM, Prieto J, Zozaya JM, Quiroga J, Guitián R (April 1993). "Arteriovenous shunting, hemodynamic changes, and renal sodium retention in liver cirrhosis". Gastroenterology. 104 (4): 1139–45. PMID 8462804.
- ↑ Celik O, Buyuktas D, Islak C, Sarici AM, Gundogdu AS (July 2013). "The association of carotid cavernous fistula with Graves' ophthalmopathy". Indian J Ophthalmol. 61 (7): 349–51. doi:10.4103/0301-4738.109533. PMC 3759106. PMID 23571267.
- ↑ 25.0 25.1 Oskrochi Y, Razi K, Stebbing J, Crane J (January 2016). "Angiosarcoma and Dialysis-related Arteriovenous Fistulae: A Comprehensive Review". Eur J Vasc Endovasc Surg. 51 (1): 127–33. doi:10.1016/j.ejvs.2015.08.016. PMID 26482509.
- ↑ 26.0 26.1 Weinreb W, Steinfeld A, Rodil J, Esparza A, Trebbin W (July 1983). "Leiomyosarcoma arising in an arteriovenous fistula". Cancer. 52 (2): 390–2. PMID 6861080.
- ↑ Putschar WG (October 1972). "Circulation in Paget's disease of bone". N. Engl. J. Med. 287 (14): 717–8. doi:10.1056/NEJM197210052871410. PMID 5055421.
- ↑ STORSTEEN KA, JANES JM (February 1954). "Arteriography and vascular studies in Paget's disease of bone". J Am Med Assoc. 154 (6): 472–4. PMID 13117640.
- ↑ Elhammady MS, Ambekar S, Heros RC (2017). "Epidemiology, clinical presentation, diagnostic evaluation, and prognosis of cerebral dural arteriovenous fistulas". Handb Clin Neurol. 143: 99–105. doi:10.1016/B978-0-444-63640-9.00009-6. PMID 28552162.
- ↑ Newton TH, Cronqvist S (November 1969). "Involvement of dural arteries in intracranial arteriovenous malformations". Radiology. 93 (5): 1071–8. doi:10.1148/93.5.1071. PMID 5350675.
- ↑ Brown RD, Wiebers DO, Torner JC, O'Fallon WM (April 1996). "Incidence and prevalence of intracranial vascular malformations in Olmsted County, Minnesota, 1965 to 1992". Neurology. 46 (4): 949–52. PMID 8780070.
- ↑ Altin RS, Flicker S, Naidech HJ (March 1989). "Pseudoaneurysm and arteriovenous fistula after femoral artery catheterization: association with low femoral punctures". AJR Am J Roentgenol. 152 (3): 629–31. doi:10.2214/ajr.152.3.629. PMID 2783816.
- ↑ Sugahara T, Azuma M, Nakashima K, Ito K, Suzuki R, Hagio K, Uetani H, Yanaga Y, Baba Y (July 2013). "Postcatheterization radial arteriovenous fistula: balloon-assisted direct percutaneous embolization with N-butyl cyanoacrylate and 50 % glucose solution in two sessions". Jpn J Radiol. 31 (7): 505–10. doi:10.1007/s11604-013-0206-8. PMID 23609100.
- ↑ Perings SM, Kelm M, Jax T, Strauer BE (April 2003). "A prospective study on incidence and risk factors of arteriovenous fistulae following transfemoral cardiac catheterization". Int. J. Cardiol. 88 (2–3): 223–8. PMID 12714202.
- ↑ Kron J, Sutherland D, Rosch J, Morton MJ, McAnulty JH (May 1985). "Arteriovenous fistula: a rare complication of arterial puncture for cardiac catheterization". Am. J. Cardiol. 55 (11): 1445–6. PMID 3993595.
- ↑ Glaser RL, McKellar D, Scher KS (November 1989). "Arteriovenous fistulas after cardiac catheterization". Arch Surg. 124 (11): 1313–5. PMID 2818187.
- ↑ Sidawy AN, Neville RF, Adib H, Curry KM (April 1993). "Femoral arteriovenous fistula following cardiac catheterization: an anatomic explanation". Cardiovasc Surg. 1 (2): 134–7. PMID 8076015.
- ↑ Kim D, Orron DE, Skillman JJ, Kent KC, Porter DH, Schlam BW, Carrozza J, Reis GJ, Baim DS (February 1992). "Role of superficial femoral artery puncture in the development of pseudoaneurysm and arteriovenous fistula complicating percutaneous transfemoral cardiac catheterization". Cathet Cardiovasc Diagn. 25 (2): 91–7. PMID 1544161.
- ↑ Groth KA, Erik Nielsen-Kudsk J, Nørgaard BL, Andersen NH (August 2013). "Internal mammary arteriovenous fistula found late after aortic root replacement". Eur Heart J Cardiovasc Imaging. 14 (8): 831. doi:10.1093/ehjci/jet025. PMID 23847386.
- ↑ Kawano Y, Tamura A, Kadota J (June 2007). "An unusual femoral arteriovenous fistula following cardiac catheterization". Int. J. Cardiol. 119 (1): e17–8. doi:10.1016/j.ijcard.2007.01.080. PMID 17449120.
- ↑ Nagata T, Johno H (December 2017). "Radial arteriovenous fistula following coronary angiography". J Card Surg. 32 (12): 805–806. doi:10.1111/jocs.13257. PMID 29235152.
- ↑ Ricolfi F, Valiente E, Bodson F, Poquet E, Chiras J, Gaston A (December 1995). "Arteriovenous fistulae complicating central venous catheterization: value of endovascular treatment based on a series of seven cases". Intensive Care Med. 21 (12): 1043–7. PMID 8750133.
- ↑ Tran HS, Burrows BJ, Zang WA, Han DC (September 2006). "Brachial arteriovenous fistula as a complication of placement of a peripherally inserted central venous catheter: a case report and review of the literature". Am Surg. 72 (9): 833–6. PMID 16986396.
- ↑ Thadani U, Pratt AE (September 1971). "Profunda femoral arteriovenous fistula after percutaneous arterial and venous catheterization". Br Heart J. 33 (5): 803–5. PMC 487256. PMID 5115025.
- ↑ Chan CC, Lee V, Chu W, Tam YH, Li CK, Shing MM (December 2012). "Carotid jugular arteriovenous fistula: an unusual complication of internal jugular vein catheterization in children". Pediatr Blood Cancer. 59 (7): 1302–4. doi:10.1002/pbc.24137. PMID 22415906.
- ↑ Melo NC, Mundim JS, Costalonga EC, Lucon AM, Santello JL, Praxedes JN (May 2009). "Three cases of hypertension and renal arteriovenous fistula with a de novo fistula". Arq. Bras. Cardiol. 92 (5): e36–8, e63–5. PMID 19629281.
- ↑ McAlhany JC, Black HC, Hanback LD, Yarbrough DR (July 1971). "Renal arteriovenous fistula as a cause of hypertension". Am. J. Surg. 122 (1): 117–20. PMID 5091842.
- ↑ Goldberg A, Tsipis A, Rosenfeld I (June 2013). "Arteriovenous fistula after cardiac catheterization from a radial approach". Isr. Med. Assoc. J. 15 (6): 313–4. PMID 23882900.
- ↑ Doblas, M.; Cuesta, M. A.; Garcia, L. Garcia; Diaz, E. Garcia; Bengoechea, E. (2016). "Distal Venous Hypertension in Side-to-Side Arteriovenous Fistulae". Phlebology: The Journal of Venous Disease. 3 (2): 135–138. doi:10.1177/026835558800300211. ISSN 0268-3555.
- ↑ 50.0 50.1 Jonasson SA, Jøssang DE, Haaverstad R, Wendelbo Ø, Pedersen G (February 2016). "Arteriovenous fistula of the groin in a drug abuser with endocarditis". J Surg Case Rep. 2016 (2). doi:10.1093/jscr/rjw001. PMC 5654361. PMID 26829963.
- ↑ Gabow P, de Torrente A, Holt S, Kelly GL (May 1976). "Arteriovenous fistula from drug abuse. Implications for hemodialysis". JAMA. 235 (20): 2220–1. PMID 946848.
- ↑ Du Toit DF, Van der Merwe DM, Groenewald JH, De Roubaix JA (February 1983). "High-output cardiac failure associated with an iliac artery aneurysm and arteriovenous fistula. A case report". S. Afr. Med. J. 63 (8): 293–4. PMID 6823650.
- ↑ Rehman S, Sinclair H, Rodway A, Kovalic A, Webb-Peploe K, Yusuf SW (November 2017). "Same features, different diagnosis: A case of ilio-iliac arteriovenous fistula presenting as decompensated heart failure". JRSM Open. 8 (11): 2054270417739778. doi:10.1177/2054270417739778. PMC 5682584. PMID 29163978.
- ↑ Stern AB, Klemmer PJ (January 2011). "High-output heart failure secondary to arteriovenous fistula". Hemodial Int. 15 (1): 104–7. doi:10.1111/j.1542-4758.2010.00518.x. PMID 21223485.
- ↑ Malhotra K, Dhawan V, Dalal P, Ariyamuthu V, Bichu P, Botdorf J, Khanna R (October 2012). "Decompensated high-output congestive heart failure in a patient with AVF and the role of right heart catheterization: a case study". Hemodial Int. 16 Suppl 1: S58–61. doi:10.1111/j.1542-4758.2012.00749.x. PMID 23036039.
- ↑ 56.0 56.1 56.2 56.3 Jariwala U, Hasan RK, Thorn EM, Zakaria S (March 2015). "An unusual case of infective endocarditis involving a right coronary artery to superior vena cava fistula". Catheter Cardiovasc Interv. 85 (4): 620–4. doi:10.1002/ccd.25597. PMID 25044393.
- ↑ Sasaki Y, Oda S, Fujikata S, Tanimoto S, Kan M (July 2014). "[Renal arteriovenous fistula with a vein aneurysm: a case report]". Hinyokika Kiyo (in Japanese). 60 (7): 333–6. PMID 25142960.
- ↑ Hastaoglu IO, Tokoz H, Ozgen A, Bilgen F (May 2017). "An unusual complication following surgical banding procedure for steal syndrome: band migration and sudden arteriovenous fistula aneurysm formation". J Vasc Access. 18 (3): e31–e32. doi:10.5301/jva.5000650. PMID 28165573.
- ↑ Lai LF, Chen M, Chen JX, Zheng K, He XY, Li XF, Zhang X, Wang QJ, Duan CZ (April 2016). "Fistula and Infratentorial Location, Characteristics That Contribute to Cerebral Arteriovenous Malformations, Lead to the Formation of Associated Aneurysms in Patients". World Neurosurg. 88: 510–8. doi:10.1016/j.wneu.2015.10.036. PMID 26520431.
- ↑ Muramatsu M, Mizutani T, Sakurabayashi K, Maeda M, Yonekura T, Nihei H, Hyodo Y, Shinoda K, Shishido S, Sakai K (October 2018). "Novel technique for repair of arteriovenous fistula with aneurysm". J Vasc Access: 1129729818804992. doi:10.1177/1129729818804992. PMID 30324852.
- ↑ Yilmaz MB, Donmez H, Tonge M, Senol S, Tekiner A (2015). "Vertebrojugular arteriovenous fistula and pseudoaneurysm formation due to penetrating vertebral artery injury: case report and review of the literature". Turk Neurosurg. 25 (1): 141–5. doi:10.5137/1019-5149.JTN.8247-13.1. PMID 25640560.
- ↑ Serra R, Butrico L, Grande R, Placida GD, Rubino P, Settimio UF, Quarto G, Amato M, Furino E, Compagna R, Amato B, Gallelli L, de Franciscis S (2015). "Venous aneurysm complicating arteriovenous fistula access and matrix metalloproteinases". Open Med (Wars). 10 (1): 519–522. doi:10.1515/med-2015-0088. PMC 5368876. PMID 28352747.
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- ↑ Bilen N, Apaydin R, Harova G, Anadolu RY, Doğan N, Paksoy N (September 1998). "Stasis dermatitis of the hand associated with an iatrogenic arteriovenous fistula". Clin. Exp. Dermatol. 23 (5): 208–10. PMID 10233602.
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- ↑ Cheung AK, Imrey PB, Alpers CE, Robbin ML, Radeva M, Larive B, Shiu YT, Allon M, Dember LM, Greene T, Himmelfarb J, Roy-Chaudhury P, Terry CM, Vazquez MA, Kusek JW, Feldman HI (October 2017). "Intimal Hyperplasia, Stenosis, and Arteriovenous Fistula Maturation Failure in the Hemodialysis Fistula Maturation Study". J. Am. Soc. Nephrol. 28 (10): 3005–3013. doi:10.1681/ASN.2016121355. PMC 5619966. PMID 28710091.
- ↑ Shi Y, Zhu M, Cheng J, Zhang J, Ni Z (February 2016). "Venous stenosis in chronic dialysis patients with a well-functioning arteriovenous fistula". Vascular. 24 (1): 25–30. doi:10.1177/1708538115575649. PMID 25725216.
- ↑ Allon M, Robbin ML, Young CJ, Deierhoi MH, Goodman J, Hanaway M, Lockhart ME, Litovsky S (October 2013). "Preoperative venous intimal hyperplasia, postoperative arteriovenous fistula stenosis, and clinical fistula outcomes". Clin J Am Soc Nephrol. 8 (10): 1750–5. doi:10.2215/CJN.02740313. PMC 3789340. PMID 23813559.
- ↑ Guo WY, Lee CJ, Lin CJ, Yang HC, Wu HM, Wu CC, Chung WY, Liu KD (January 2017). "Quantifying the Cerebral Hemodynamics of Dural Arteriovenous Fistula in Transverse Sigmoid Sinus Complicated by Sinus Stenosis: A Retrospective Cohort Study". AJNR Am J Neuroradiol. 38 (1): 132–138. doi:10.3174/ajnr.A4960. PMID 27765737.
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- ↑ Ahmed RM, Khoury B, Wilkinson M, Parker GD, Halmagyi GM (June 2013). "Venous hypertension as the cause of intracranial hypertension in patients with transverse sinus dural arteriovenous fistula". J Neuroophthalmol. 33 (2): 102–5. doi:10.1097/WNO.0b013e318250575b. PMID 22495458.
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- ↑ Ram R, Swarnalatha G, Mahapatra S, Dakshinamurty KV (November 2014). "Embolic occlusion of arteriovenous fistula due to infective endocarditis". Indian J Nephrol. 24 (6): 400–1. doi:10.4103/0971-4065.138705. PMC 4244725. PMID 25484539.
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- ↑ Vivek G, Naha K, Ramachandran P, Rajagopal KV (July 2012). "Ectatic left circumflex artery with fistula to coronary sinus presenting with inferior wall myocardial infarction". BMJ Case Rep. 2012. doi:10.1136/bcr-2012-006473. PMC 4544331. PMID 22778478.
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- ↑ Zanati Bazan SG, Braga GP, Luvizutto GJ, Trindade AP, Pontes-Neto OM, Bazan R (June 2016). "Bihemispheric Paradoxical Cerebral Embolism in a Patient with Pulmonary Thromboembolism and Presumptive Fistula Right-to-Left Shunt". J Stroke Cerebrovasc Dis. 25 (6): e95–7. doi:10.1016/j.jstrokecerebrovasdis.2016.03.038. PMID 27105566.
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- ↑ Miyabe H, Ohte N, Kurokawa K, Goto T, Takada N, Yajima K, Akita S, Mukai S, Kimura G (2004). "Paradoxical brain embolism caused by pulmonary arteriovenous fistula and coincident pulmonary embolism--a case report". Angiology. 55 (5): 577–81. doi:10.1177/000331970405500517. PMID 15378124.
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- ↑ Takahashi F, Hiraiwa S, Takahashi G, Kondo Y, Tasaki G, Sugiyama T, Tajiri T, Sakamaki F (November 2018). "An Autopsy Case of Paradoxical Pulmonary Thromboembolism by Arteriovenous Fistula from Right Common Iliac Artery to Common Iliac Vein: A Rare Cause of Pulmonary Embolism". Am J Case Rep. 19: 1301–1305. doi:10.12659/AJCR.910982. PMID 30381754.
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- ↑ Heining D, Senior J, Prasad A, Thomas M, Bentall A, Yates PJ (October 2018). "Multi-system bleeding risk with a cutaneous angiosarcoma at an arteriovenous fistula site". Oxf Med Case Reports. 2018 (10): omy063. doi:10.1093/omcr/omy063. PMC 6142712. PMID 30250745.
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- ↑ Gale AL, Marco R, Liberman SR, Zavlin D, Echo A (September 2017). "Case Report: Angiosarcoma in the Upper Extremity Related to a Nonfunctioning Arteriovenous Fistula". Hand (N Y). 12 (5): NP132–NP135. doi:10.1177/1558944717702466. PMC 5684947. PMID 28387163. Vancouver style error: initials (help)
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- ↑ Paral KM, Raca G, Krausz T (2015). "MYC Amplification in Angiosarcoma Arising from an Arteriovenous Graft Site". Case Rep Pathol. 2015: 537297. doi:10.1155/2015/537297. PMC 4670641. PMID 26682080.
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