Traumatic Arteriovenous Fistula Research Articles

Endovascular therapy for traumatic arterial injury

To explore the clinical efficacies of endovascular therapy for traumatic arterial intima injury, arterial pseudoaneurysm and arteriovenous fistula. From October 2009 to December 2011, 24 patients of arterial intima injury, arterial pseudoaneurysm and arteriovenous fistula underwent endovascular therapy including embolism and stent implantation, etc. Among them, 14 patients were punctured directly and another 10 were punctured after the exposure of arteries. The interventions included embolism (n = 3), embolism plus covered stent implantation (n = 2), covered stent implantation (n = 12) and bare stent implantation (n = 7). And the surgical success rate was 100%. After endoluminal treatment, arterial blood flow recovered, arterial pseudoaneurysm shrank, local pain relieved and venous blood pressure decreased. As an effective therapy for traumatic arterial intima injury, arterial pseudoaneurysm and arteriovenous fistula, endovascular therapy has minimal trauma, fewer complications and satisfactory outcomes.

Endovascular Management of Extra-cranial Supra-aortic Vascular Injuries

Supra-aortic vessel injuries are uncommon but can be life-threatening and surgically challenging. Trauma to these vessels may be blunt or penetrating, including iatrogenic trauma following the insertion of central venous lines, which may be preventable. Recent advances in technology have resulted in endovascular therapy becoming a common first-line treatment, and interventional radiologists now play a major role in the management of these vascular injuries. We review the literature on the endovascular management of these types of injuries and describe a spectrum of case-based extra-cranial supra-aortic vascular injuries managed at our institution and the range of imaging appearances, including active contrast extravasation, traumatic vessel occlusion, true aneurysms, pseudoaneurysms, and arteriovenous fistulae.

Percutaneous antegrade transarterial treatment of traumatic radial arteriovenous fistula

Traumatic arteriovenous fistulas (AVF) are almost exclusively the result of penetrating trauma and there is usually a history of hemorrhage. Typically, the patient demonstrates a thrill and bruit over the site of injury. We report a woman who presented with longstanding pain and swelling of the right hand due to radial AVF that possibly occurred following an injury to the right hand that happened 10 years prior to the date of admission. Since surgery was considered high risk due to multiple fistulas and previous surgery, percutaneous coil embolization was performed via the ipsilateral antegrade radial approach.

A Case of Traumatic Inferior Mesenteric Arteriovenous Fistula

Inferior mesenteric arteriovenous fistula is rare and may be congenital or acquired. Affected patients present with abdominal pain, mass, or manifestations of portal hypertension and bowel ischemia. Until now, inferior mesenteric arteriovenous fistula due to trauma has not been reported. Herein, we report a case of a 53-year-old woman who had inferior mesenteric arteriovenous fistula considered to have originated from remote blunt trauma that was successfully treated by surgical resection of only the arteriovenous fistula without colectomy. To our knowledge, this is the first case of traumatic inferior mesenteric arteriovenous fistula.

Concealed Postpartum Hemorrhage Treated With Transcatheter Arterial Embolization

Postpartum hemorrhage is an obstetric emergency and is a major preventable cause of maternal morbidity and mortality. An arteriovenous fistula is a rare cause of concealed postpartum hemorrhage. A 20-year-old woman spontaneously delivered at 40 0/7 weeks of gestation. Twelve hours after delivery, she became hemodynamically unstable, developing a large left vaginal hematoma. An angiogram revealed extravasation originating from the right pudendal artery with early filling of a draining vein, consistent with a traumatic arteriovenous fistula. Complete occlusion of the fistula was achieved by embolizing a branch of the right pudendal artery. The postprocedure course was uneventful. A vaginal arteriovenous fistula should be considered in cases of concealed postpartum hemorrhage; transcatheter arterial embolization is an effective treatment for these cases.

Tinzaparin Versus Dalteparin for Periprocedure Prophylaxis of Thromboembolic Events in Hemodialysis Patients: A Randomized Trial

Low-molecular-weight heparin (LMWH) is cleared predominantly by the kidneys and hence there is uncertainty about the safety of its use in hemodialysis (HD) patients. Our primary objective was to compare whether tinzaparin and dalteparin differentially accumulate in HD patients. Open-label randomized controlled trial. HD patients undergoing periprocedure bridging anticoagulation. After warfarin therapy was discontinued, participants were randomly assigned to either 3 daily doses of tinzaparin (175 IU/kg) or dalteparin (200 IU/kg), with 2 intervening HD treatments between the first dose of study drug and their procedure. The primary outcome was predialysis anti-Xa levels 20 to 24 hours after the third LMWH dose (therapeutic target, <0.2 IU/mL). Secondary outcomes included thromboembolic events and major bleeding. Of 29 eligible and consenting patients, 17 patients received tinzaparin and 12 patients received dalteparin. Mean predialysis anti-Xa level 20-24 hours after the third LMWH dose was 0.37 ± 0.23 (SD) IU/mL for tinzaparin and 0.62 ± 0.41 IU/mL for dalteparin (P = 0.1), indicating clinically important accumulation for both drugs. No invasive procedures were canceled due to study drug accumulation. 4 patients experienced serious adverse events (1 major bleed after traumatic arteriovenous fistula puncture in the tinzaparin arm, 2 non-ST-elevation myocardial infarctions [1 in each group], and 1 upper-extremity deep venous thrombosis [dalteparin group]). Small sample size. Dalteparin and tinzaparin significantly accumulate in HD patients at therapeutic doses. "Bridging therapy" with LMWHs at therapeutic doses in HD patients who require temporary interruption of warfarin therapy has the potential for complications and is of uncertain benefit. Other anticoagulation strategies, including no bridging therapy or intravenous heparin, need comparative evaluation in this unique patient population.

Delayed presentation of traumatic infrapopliteal arteriovenous fistula and pseudoaneursym in a 10-year-old boy managed by coil embolization

Blunt traumatic arteriovenous fistulae of the extremities are rare in children. We report the case of a 10-year-old boy with a traumatic infrapopliteal arteriovenous fistula and concomitant pseudoaneurysm diagnosed 2 months after he was struck by a car. It was definitively managed with coil embolization. Postprocedure, the vascular anatomy of the patient's right calf was well preserved. He had complete resolution of his symptoms immediately after the intervention and continues to do well 6 months later.

Iatrogenic arteriovenous fistula in the Arm in an infant: Diagnostic and therapeutic considerations

Iatrogenic arteriovenous fistulas (AVF) are well described in adults; however, this complication is rarely described and reported in infants. We report the case of a 3-month-old infant with complicated gastroschisis requiring multiple venipunctures who presented with signs and symptoms suggestive of traumatic arteriovenous fistula. Ultrasound imaging confirmed the presence of a wide-necked AVF between the brachial artery and vein. The fistula was surgically repaired. This case report describes the clinical imaging and treatment options for infants with iatrogenic AVF.

An unusual presentation of foreign body in the common carotid artery.

Penetrating trauma to neck resulting in arteriovenous (AV) fistula and aneurysms involving the carotid system are uncommon injuries with life-threatening consequences. We report here a case of a young factory worker who developed a traumatic AV fistula with false aneurysm, with however, no other complications. He was successfully operated when he presented to us two months after the injury and is doing well in follow-up.

Incremental Role of Three-Dimensional over Two-Dimensional Ultrasound in the Assessment of Traumatic Peripheral Arteriovenous Fistula

We present a patient with an accidental self-inflicted stab wound to his right thigh in whom three-dimensional (3D) ultrasound was able to find two communications between the right femoral artery and the femoral vein, in contrast to two-dimensional (2D) peripheral ultrasound which could find only one communication between them, thereby showing an incremental value of 3D over 2D ultrasound.

False Traumatic Aneurysms and Arteriovenous Fistulas: Retrospective Analysis

The purpose of this study was to analyze the incidence, clinical presentation, diagnosis, and treatment of false traumatic aneurysms and arteriovenous fistulas as well as the outcomes of the patients. A retrospective, 16-year survey has been conducted regarding the cases of patients who underwent surgery for false traumatic aneurysms (FTA) of arteries and traumatic arteriovenous fistulas (TAVF). Patients with iatrogenic AV fistulas and iatrogenic false aneurysms were excluded from the study. There were 36 patients with TAVF and 47 with FTA. In all, 73 (87.95%) were male, and 10 (12.05%) were female, with an average age of 36.93years (13-82years). In 25 (29.76%) cases TAVF and FTA appeared combat-related, and 59 (70.24%) were in noncombatants. The average of all intervals between the injury and surgery was 919. 8days (1day to 41years) for FTA and 396.6days (1day to 9years) for TAVF. Most of the patients in both groups were surgically treated during the first 30days after injury. One patient died on the fourth postoperative day. There were two early complications. The early patency rate was 83.34%, and limb salvage was 100%. There were no recurrent AV fistulas that required additional operations. Because of their history of severe complications, FTA and TAV fistulas require prompt treatment. The treatment is simpler if there is only a short interval between the injury and the operation. Surgical endovascular repair is mostly indicated.

Voice Matters: Late Presentation of an Iatrogenic Vertebral Arteriovenous Fistula after Liver Transplantation in Early Childhood with Successful Endovascular Treatment

Central venous cannulation is known to be a frequent cause of iatrogenic morbidity. Children are at particular risk for anatomical reasons, especially those who require complex surgical interventions because central venous access is frequently needed before, during, and after the procedure. Immediate complications, such as failure of cannulation, pneumothorax, arterial puncture, and nerve injury, are well documented. Traumatic vertebral artery pseudoaneurysms and arteriovenous fistulas are however uncommon lesions in children. Whilst surgical fistula closure has been traditionally advocated as first-line treatment, endovascular noninvasive techniques are becoming increasingly available in childhood. We report the successful endovascular treatment of a 14-year-old girl with a large vertebro-subclavian fistula 13 years after orthotopic liver transplantation.

Endovascular repair of posttraumatic multiple femoral-femoral and popliteal-popliteal arteriovenous fistula with Viabahn and excluder stent graft

Traumatic arteriovenous (AV) fistula is considered to be a pathologic communication between the arterial and venous systems following injury caused mostly by firearms, sharp objects or blasting agents. Almost 50% of all traumatic AV fistulas are localized in the extremities. In making diagnosis, besides injury anamnesis data, clinical image is dominated by palpable thrill and auscultator continual sounds at the site of fistula, extremities edemas, ischemia distally of fistula, pronounced varicose syndrome, and any signs of the right heart load in high-flow fistulas. We presented a male 32-year-old patient self-injured the region of the right lower and upper leg by shotgun during hunting in 2005. The same day the patient was operated on in a tertiary traumatology health care institution under the diagnosis of vulnus sclopetarium femoris et cruris dex; AV fistula reg popliteae dex; fractura cruris dex. The performed surgery was ligatura AV fistulae; reconstructio a. popliteae cum T-T anastomosis; fasciotomia cruris dex. Postoperatively, in the patient developed a multiple AV fistula of the femoral and popliteal artery and neighboring veins. The patient was two more times operated on for closing the fistula but with no success. Three years later the patient was referred to the Clinic for Vascular Surgery, Military Medical Academy, Belgrade, Serbia. A physical examination on admission showed the right upper leg edema, pronounced varicosities and high thrill, signs of the skin induration and initial ischemia with ulceration in the right lower leg, as well as numerous scars in the inner side of the leg from the previously performed operations. Due to the right heart load there were also present easy getting tired, tachypnoea and tachycardia. CT and contrast angiography verified the presence of multiple traumatic AV fistulas in the surface femoral and popliteal artery and neighboring veins of the highest diameter being 1 cm. Also, numerous metallic balls--grains of shotgun were present. After the preoperative preparation under local infiltrative anesthesia, transfemoral endovascular reconstruction was done of the surface femoral and popliteal artery by the use of stent grafts Viabahn 6 x 50 mm and excluder PXL 161 007. Within the immediate postoperative course a significant reduction of the leg edema and disappearance of thrill occurred, and, latter, healing of ulceration, and disappearance of signs of the foot ischemia. Also, patient's both cardiac and breathing functions became normal. In patients with chronic traumatic AV fistulas in the femoropopliteal region, especially with multiple fistulas, the gold standard is their endovascular recon struction which, although being minimally traumatic and invasive, offers a complete reconstruction besides keeping integrity of both distal and proximal circulation in the leg.

Traumatic arteriovenous fistula supplied by the middle meningeal artery

We read with great interest the article entitled “Traumatic fistula between the middle meningeal artery and the sphenoparietal sinus” by Unterhofer et al. [3] in the Oct 2009 issue of Acta Neurochirurgica. The authors presented a case of post-traumatic fistula between the middle meningeal artery and the sphenoparietal sinus and discussed the relevant literature. They pointed out that the laterobasal fractures involving the floor of the middle temporal fosse can lead to fistula formation between the middle meningeal artery and the sphenoparietal sinus. Therefore, they stressed the need to include selective angiographic catheterization of the external carotid artery when bone damage after head injury involves the lateral skull base and a fistula is suspected on clinical grounds. We agree with the authors’ opinion; however, we would like to comment on this issue. We previously reported a case of a traumatic middle meningeal arteriovenous fistula on the opposite side of a head injury [2].The patient hit the right side of their head. Computed tomography scans demonstrated a traumatic right temporal bone fracture, whereas there was no fracture on the left side. Cerebral angiograms 1 year after the head injury showed a dural arteriovenous fistula, which was fed by the left middle meningeal artery. Draining systems were mainly the middle meningeal vein and the sphenoparietal sinus. A review of the literature showed that there are some reported cases of traumatic middle meningeal arteriovenous fistula without skull fracture on the side of the lesion. Dura mater–bone separation [1] or distortion of the dura mater may cause the formation of a traumatic arteriovenous fistula fed by the middle meningeal artery without skull fracture. We suggest that a selective angiography of the external carotid artery should be performed in cases with clinical suspicions, even if there is no skull fracture.

Fístula arteriovenosa postraumática: tratamiento endovascular. Revisión de la literatura y presentación de un caso clínico

Traumatic arteriovenous fistulas of the head and neck region are uncommon. The majority are due to penetration of blunt injury. We describe a successful endovascular treatment of a posttraumatic fistula between the left maxillary artery and the external jugular vein due to a penetration injury. This case and a review of the literature illustrate the causes, manifestations, image studies and treatment for a posttraumatic fistula between the maxillary artery and the external jugular vein. This case demonstrate the utility of endovascular treatment of head and neck injuries complications.

Traumatic arteriovenous fistula 52 years after injury

Untreated traumatic arteriovenous fistulae (AVF) have been associated with aneurysmal dilatation of the involved artery and vein, congestive heart failure, and limb ischemia. Open surgical repair of these lesions can be challenging due to the elevated venous pressure and surrounding inflammation. This case report describes a hybrid open and endovascular approach to treatment of a traumatic AVF in the right groin, presenting with aneurysmal ileo-femoral arteries and veins and pulmonary hypertension. It provides a rare look at the natural history of a traumatic AVF over 50 years following the initial injury.

Traumatic arteriovenous fistula of the upper lip: A case report

Traumatic arteriovenous fistula (AVF) is often challenging to diagnose and manage. Those involving the external carotid artery or its branches occur relatively rarely. We present a case of a vascular mass of the upper lip at the right side with a previous history of blunt trauma. AVF of the upper lip can be successfully managed with the preservation of lip function and the cosmetic appearance through surgical excision without embolisation if there is good local access to the lesion.

Vascular malformations and arteriovenous fistulas of the kidney

Vascular malformations of the kidney are disease processes that involve renal veins and arteries and include congenital arteriovenous malformations (AVMs) and arteriovenous fistulas. AVMs are congenital communications between arteries and veins with a vascular nidus that bypass the capillary bed. Congenital AVMs are rare and subclassified in cirsoid, angiomatous, and aneurysmal types. Congenital AVMs are different from iatrogenic or traumatic arteriovenous fistulas (AVF), which are characterized by a single direct communication between an artery and a vein without an intervening vascular nidus. These lesions may present with a wide range of signs and symptoms that vary from hypertension to renal masses. Imaging is valuable in the detection and characterization of AVM and AVF. The presence of arteriovenous shunting characterizes AVM and AVF. These lesions represent an important group of entities for diagnostic consideration, and understanding the vascular anatomy helps in guiding for proper treatment. This article describes the imaging features of each lesion that help to differentiate it from the others and the endovascular therapies to treat these vascular processes and their possible complications.

Severe Refractory Hypoxemia 16 Years After a Gunshot Injury

A 53-year-old man presented with a history of depressant syndrome. He had been hospitalized 16 years previously because of penetrating traumatic injury of the left hemithorax by bullet secondary to a suicide attempt. Recently, he came to the emergency department for an illness leading to the discovery of severe hypoxemia refractory to nasal oxygen therapy. The arterial blood gas measurements revealed a pH of 7.41, a Paco2 of 41 mm Hg, a Pao2 of 45 mm Hg, and O2 saturation of 83% on ambient air; the Pao2 increased to 85 mm Hg on inspired oxygen of 100%. resulting in a shunt of 30%. Multidetector computed tomography–angiography of the chest showed clearly a giant proximal pulmonary arteriovenous fistula (Figure 1A and B and …

Late, Acute Presentation of a Large Brachial Artery Aneurysm Following Ligation of a Brescia-Cimino Arteriovenous Fistula

The development of pan-arterial dilatation proximal to longstanding traumatic arteriovenous fistulae (AVF) was first described by John Hunter over two centuries ago. This is thought to be due to abnormal and hyperdynamic arterial flow patterns proximal to the AVF, which renders the proximal arteries particularly susceptible to atherosclerotic change and aneurysmal dilatation. Aneurysmal arterial dilatation has been described infrequently as a late complication of traumatic AVF formation, however, we describe a case in which acute on chronic late brachial artery aneurysmal dilatation occurred following previous Brescia-Cimino AVF formation, which had been ligated several years earlier after renal transplantation. Late, Acute Presentation of a Large Brachial Artery Aneurysm Following Ligation of a Brescia-Cimino Arteriovenous FistulaEJVES ExtraVol. 18Issue 6PreviewThe development of pan-arterial dilatation proximal to longstanding traumatic arteriovenous fistulae (AVF) was first described by John Hunter over two centuries ago.1 This is thought to be due to abnormal and hyperdynamic arterial flow patterns proximal to the AVF, which renders the proximal arteries particularly susceptible to atherosclerotic change and aneurysmal dilatation.2–4 Aneurysmal arterial dilatation has been described infrequently as a late complication of traumatic AVF formation,5,6 however, we describe a case in which acute on chronic late brachial artery aneurysmal dilatation occurred following previous Brescia-Cimino AVF formation, which had been ligated several years earlier after renal transplantation. Full-Text PDF Open Access