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AV fistula

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Arteriovenous fistula

Definition

Abnormal connection between artery and vein which bypasses capillary bed

Aetiology

  • congenital
  • acquired:
    - surgically created for haemodialysis
    - penetrating trauma
    - iatrogenic eg following surgical dissection of artery, cannulation of artery or vein

Clinical features

  • depend in part on anatomical location of fistula.
  • ± ischaemic symptoms distal to fistula
  • chronic venous insufficiency: swollen limb, tortuous superficial veins, venous eczema
  • skin temperature higher over fistula
  • large fistulae may lead to high output cardiac failure
  • compression of large fistulae may lead to reflex slowing of the heart
  • diagnosis usually obvious on clinical examination of superficial fistulae

Investigations

  • arteriography

Treatment

  • options are surgical ligation, embolization and radiotherapy
  • congenital fistulae are often difficult to treat because of multiple fistulae and the tendency for more fistulae to open up following ligation of the more obvious ones. Conservative treatment with compression stockings may be the best option

 

© Charles Gomersall July 1999

 

©Charles Gomersall, October, 2009 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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