Iatrogenic arteriovenous fistula

Case contributed by Dr Matt A. Morgan

Presentation

Evaluation of thrill in patient's antecubital fossa, post femoral stent placement via antecubital access.

Patient Data

Age: 65-70Y
Ultrasound

Color and spectral Doppler waveforms

Grayscale, color, and spectral Doppler appearance of an arteriovenous fistula (AVF) in the left upper extremity.

Case Discussion

An arteriovenous fistula (AVF) is a potential complication from percutaneous transarterial/transvenous procedures, with a rate of 0.6% in patients undergoing femoral access for cardiac catheterization.

Although the fistula can sometimes be seen (as in this case), it may also be difficult to visualize directly. In this situation, it becomes important to look for the secondary sign of arterialization of the veins upstream from the access site. Even if one is unable to visualize an arteriovenous fistula directly, arterialization of the upstream vein allows one to confidently suggest a diagnosis of AVF.

Another less specific piece of spectral Doppler evidence is an increase in the amount of diastolic flow (and a corresponding decrease in RI). Arteries in resting muscle tend to have low diastolic flow as the skeletal muscle end arteries are contracted and resistance in the skeletal muscle arterial bed is high. High diastolic flow implies that the incoming artery has the option of shunting into a low-resistance vein.

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Case information

rID: 31727
Case created: 24th Oct 2014
Last edited: 10th Sep 2015
System: Vascular
Inclusion in quiz mode: Included

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