Skip to Main Content

+

  • • Congenital or acquired

    • Abnormal connection between artery and vein; located anywhere in body

++

Congenital

+

  • • Systemic effect minimal

    • Noted in infancy or childhood

    • Limb involvement leads to hypertrophied, longer extremity

    • Frequently involve brain, viscera, lungs

    Osler-Weber-Rendu syndrome (autosomal dominant): Hemorrhages in form of epistaxis, GI bleeding, polycythemia, cyanosis, clubbing

++

Acquired

+

  • • Enlarge rapidly

    • Can cause heart failure

    • Generally, result from trauma or disease

    Venous malformations: Rarely cause hemodynamic effects

++

Epidemiology

++

Acquired

+

  • • Most commonly a result of traumatic injury

    • Iatrogenic injury after angiography or angioplasty common

    • Connective tissue disorders (Ehlers-Danlos), erosion of mycotic aneurysm, communication with prosthetic graft, neoplastic invasion can cause false aneurysm and arteriovenous fistula

    • Rare cause is injury to aorta and inferior vena cava after excision of herniated disk

++

Symptoms and Signs

+

  • • Determine time of onset and presence of associated disease

    • Continuous murmur may be heard

    • Palpable thrill and increased skin temperature

    • Proximal vein dilatation, distal pulse diminished, distal coolness

    Tachycardia: Increased cardiac output

    Branham sign: Compression of fistula results in slowed heart rate

    Venous malformations: Mass; may be tender; no hemodynamic effects

++

Imaging Findings

+

  • • MRI study of choice for peripheral AV malformations

    • Angiograms give precise delineation of AV fistulas

+

  • • Evaluate for signs of systemic or distant intravascular infection

+

  • • Physical exam

    • Duplex US or MRI for most peripheral lesions

    • Occasionally, use angiography to delineate further

+

  • • Not all require treatment

++

Venous Fistulas

+

  • • Compression garments when possible

    • Injection of sclerosing agents possible

++

AV Fistulas

+

  • • Monitor small peripheral fistulas

    • Most managed with radiographic embolization; head and neck, pelvis best

    Surgical: Ligate all feeding vessels; amputate extremity; repair of fistula, oversewing defects (avoid for congenital fistulas)

++

Congenital

+

  • • En bloc resection of all tissue involved in fistula

++

Surgery

++

Indications

+

  • • Hemorrhage

    • Expanding false aneurysm

    • Severe venous or arterial insufficiency

    • Cosmesis

    • Heart failure

++

Contraindications

+

  • • Congenital fistula (relative)

++

Prognosis

+

  • • Vary according to extent, location, and type

    • Traumatic type has better prognosis

    • Congenital has worse prognosis because of high recurrence

++

References

Jacobowitz GR et al. Transcatheter embolization of complex pelvic vascular malformations: results and long-term follow-up. J Vasc Surg. 2001;33:51.  [PubMed: 11137923]
White RI Jr et al. Long-term outcome of embolotherapy and surgery for high-flow extremity arteriovenous maformations. J Vasc Interv Radiol. 2000;11:1285.  [PubMed: 11099238]
Mattle HP et ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.