Congenital arteriovenous fistulas of the hand

Abstract

T here is little agreement regarding the management of the congenital arteriovenous fistula of the hand. Since a congenital arteriovenous fistula of the hand was first surgically ligated in 1867, I authors have consistently recorded frustration in regard to its operative management. Excision in any but the most sharply delineated fistulas often has been unsuccessful and has been associated with serious complications. 26 The trauma of operation reportedly has caused the lesion to progress with locally invasive characteristics similar to malignancy. 6 A process apparently localized to a single digit may extend proximally to involve the forearm or arm. Reports of the treatment of congenital arteriovenous fistulas usually describe multiple operations with repeated skin sloughs, gradual proximal extension, digital ischemia, and with occasional loss of the digit. The purpose of this paper is to review the operative treatment of the congenital arteriovenous fistula, to report four previously unrecorded cases, and to suggest some diagnostic studies which may help to differentiate those digits amenable to operative excision of the fistulous area from those best treated conservatively or by amputation of the digit.