-
Kidney360 Feb 2022
Topics: Arteriovenous Fistula; Arteriovenous Shunt, Surgical; Humans; Renal Dialysis
PubMed: 35373129
DOI: 10.34067/KID.0008012021 -
Journal of Ultrasound in Medicine :... Jan 2022To analyze and classify arterial supply and venous drainage of postcatheterization femoral arteriovenous fistulas (AVFs). (Review)
Review
OBJECTIVE
To analyze and classify arterial supply and venous drainage of postcatheterization femoral arteriovenous fistulas (AVFs).
METHODS
A review of extremity Doppler reports identified 77 femoral AVFs in 75 patients. Doppler exams were reviewed retrospectively. Fistulas were classified as above or below the common femoral artery bifurcation and subclassified based on the location of arterial inflow and venous outflow.
RESULTS
Arterial inflow originated above the femoral bifurcation in 32 cases. The communication was between the common femoral artery and the superficial circumflex iliac vein in 25 of 32 cases and between a branch of the common femoral or external iliac artery and the common femoral or external iliac vein in 4 of 32 cases. In 3 of 32 cases, AVFs arose from the common femoral artery, but the venous outflow was not determined. Arterial inflow originated from the superficial femoral artery in 23 cases. Venous outflow originated from the common femoral vein in 10 of 23 cases, the femoral vein in 7 of 23 cases, and the lateral circumflex femoral vein in 6 of 23 cases. Arterial inflow originated from the deep femoral artery in 12 cases. Venous outflow originated from the common femoral vein in 6 of 12 cases and from the lateral circumflex femoral vein 6 of 12 cases. In 8 cases, the AVF originated below the bifurcation, but the arterial inflow was not classified. In 2 cases, it was impossible to determine if the AVF originated above or below the bifurcation.
CONCLUSIONS
Iatrogenic femoral AVFs arise above the femoral bifurcation more often than previously recognized. Classification based on the arterial inflow and venous outflow provides a straightforward means of describing these fistulas.
Topics: Arteriovenous Fistula; Femoral Artery; Humans; Iatrogenic Disease; Iliac Vein; Retrospective Studies
PubMed: 33720458
DOI: 10.1002/jum.15696 -
Neurology Sep 2023In this review, we describe the pathophysiology, diagnosis, and treatment of spinal dorsal intradural arteriovenous fistulas (DI-AVFs), focusing on novel research areas.... (Review)
Review
In this review, we describe the pathophysiology, diagnosis, and treatment of spinal dorsal intradural arteriovenous fistulas (DI-AVFs), focusing on novel research areas. DI-AVFs compose the most common subgroup of spinal arteriovenous lesions and most commonly involve the thoracic spine, followed by lumbar and sacral segments. The pathogenesis underlying DI-AVFs is an area of emerging understanding, thought to be attributable to venous congestion and hypertension that precipitate ascending myelopathy. Patients with DI-AVFs typically present with motor, sensory, or urinary dysfunction, although a wide swath of other less common symptoms has been reported. DI-AVFs can be subdivided by spinal region, which in turn is associated with 4 distinct clinical phenotypes: craniocervical junction (CCJ), subaxial cervical, thoracic, and lumbosacral. Patients with CCJ and lumbosacral DI-AVFs have particularly interesting presentations and treatment considerations. High-value diagnostic findings on MRI include flow voids, missing-piece sign, and T2-weighted intramedullary hyperintensity. However, digital subtraction angiography is the gold standard for diagnosis and localization of DI-AVFs and for definitive treatment planning. Surgical disconnection of DI-AVFs is almost universally curative and frontline treatment, especially for CCJ and lumbosacral DI-AVFs. Endovascular techniques evolve in promising ways, such as improved visualization, distal access, and liquid embolic techniques. The pathophysiology of DI-AVFs is better understood using newly identified radiologic diagnostic markers. Despite new techniques and devices introduced in the endovascular field, surgery remains the gold-standard treatment for DI-AVFs.
Topics: Humans; Spinal Cord; Arteriovenous Fistula; Spine; Spinal Cord Diseases; Magnetic Resonance Imaging; Central Nervous System Vascular Malformations
PubMed: 37185123
DOI: 10.1212/WNL.0000000000207327 -
Texas Heart Institute Journal Mar 2023
Topics: Humans; Veins; Radial Artery; Arteriovenous Fistula; Catheterization; Arteriovenous Shunt, Surgical
PubMed: 36972538
DOI: 10.14503/THIJ-22-7995 -
Portuguese Journal of Cardiac Thoracic... May 2024
Topics: Humans; Iatrogenic Disease; Arteriovenous Fistula; Brachiocephalic Veins; Male; Female; Middle Aged
PubMed: 38743521
DOI: 10.48729/pjctvs.382 -
Child's Nervous System : ChNS :... Jun 2024Pediatric non-galenic pial arteriovenous fistulas (pAVFs) are rare vascular malformations that are characterized by a pial arterial-venous connection without an... (Review)
Review
INTRODUCTION
Pediatric non-galenic pial arteriovenous fistulas (pAVFs) are rare vascular malformations that are characterized by a pial arterial-venous connection without an intervening capillary bed. Outcomes and treatment strategies for pAVFs are highly individualized, owing to the rarity of the disease and lack of large-scale data guiding optimal treatment approaches.
METHODS
We performed a systematic review of pediatric patients (< 18 years at diagnosis) diagnosed with a pAVF by digital subtraction angiogram (DSA). The demographics, treatment modalities, and outcomes were documented for each patient and clinical outcome data was collected. Descriptive information stratified by outcome scores were classified as follows: 1 = excellent (no deficit and full premorbid activity), 2 = good (mild deficit and full premorbid activity), 3 = fair (moderate deficit and impaired activity), 4 = poor (severe deficit and dependent on others), 5 = death.
RESULTS
A total of 87 studies involving 231 patients were identified. Median age at diagnosis was 3 years (neonates to 18 years). There was slight male preponderance (55.4%), and 150 subjects (81.1%*) experienced excellent outcomes after treatment. Of the 189 patients treated using endovascular approaches, 80.3% experienced excellent outcomes and of the 15 patients surgically treated subjects 75% had an excellent outcome. The highest rate of excellent outcomes was achieved in patients treated with Onyx (95.2%) and other forms of EvOH (100%). High output heart failure and comorbid vascular lesions tended to result in worse outcomes, with only 54.2% and 68% of subjects experiencing an excellent outcome, respectively. *Outcomes were reported in only 185 patients.
CONCLUSION
pAVFs are rare lesions, necessitating aggregation of patient data to inform natural history and optimal treatment strategies. This review summarizes the current literature on pAVF in children, where children presenting with heart failure as a result of high flow through the lesion were less likely to experience an excellent outcome. Prospective, large-scale studies would further characterize pediatric pAVFs and enable quantitative analysis of outcomes to inform best treatment practices.
Topics: Humans; Child; Arteriovenous Fistula; Pia Mater; Child, Preschool; Adolescent; Infant; Female; Infant, Newborn; Treatment Outcome; Male; Intracranial Arteriovenous Malformations
PubMed: 38506930
DOI: 10.1007/s00381-024-06352-5 -
Operative Neurosurgery (Hagerstown, Md.) Jun 2020Spinal dural arteriovenous fistulas (AVFs) have been categorized on the basis of the Anson and Spetzler classification into 4 types. Type I is the most common type and...
Spinal dural arteriovenous fistulas (AVFs) have been categorized on the basis of the Anson and Spetzler classification into 4 types. Type I is the most common type and describes an abnormal connection between a radicular artery at the nerve root sleeve and an intradural draining vein. This communication results in progressive dilatation and mass effect from the draining vein experiencing arterial pressures without intervening arterioles. In this patient, preoperative angiography showed a type I dural AVF. A laminoplasty was performed to provide dural exposure, and a midline durotomy was performed. Indocyanine green (ICG) angiography was used to visualize flow within the fistula. This dorsal dural AVF demonstrated the characteristic slow venous flow. Pressure recordings were obtained and confirmed the elevated venous pressure observed in these lesions. Bipolar coagulation of the fistulous point was performed, and the vessel was removed at the site of the root entry zone to permit pathologic confirmation of the arteriovenous interface. Intraoperative ICG angiography findings confirmed disconnection. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
Topics: Angiography; Arteriovenous Fistula; Central Nervous System Vascular Malformations; Humans; Spine; Vascular Surgical Procedures
PubMed: 32107554
DOI: 10.1093/ons/opaa031 -
Vascular and Endovascular Surgery Nov 2022Penetrating injuries of the neck involving major vessels are associated with high morbidity and mortality. A traumatic arteriovenous (AV) fistula can provide a...
Penetrating injuries of the neck involving major vessels are associated with high morbidity and mortality. A traumatic arteriovenous (AV) fistula can provide a protective effect by decompressing the injured arterial structure and prevent massive blood loss and airway compression. We present a novel description of CCA (common carotid artery) transection with associated protective AV fistula. Protective AV fistulae have been uncommonly described, and to our knowledge, this is the first case involving carotid transection with associated protective AV fistula ultimately allowing lifesaving operative repair.
Topics: Arteriovenous Fistula; Carotid Artery, Common; Humans; Treatment Outcome; Vascular System Injuries
PubMed: 35726740
DOI: 10.1177/15385744221075008 -
The American Journal of Medicine Jul 2021
Topics: Arteriovenous Fistula; Female; Heart Failure; Humans; Microscopic Polyangiitis; Middle Aged; Postoperative Complications; Renal Dialysis
PubMed: 33621532
DOI: 10.1016/j.amjmed.2021.01.029 -
Journal of the College of Physicians... Apr 2022To determine the difference in patency and complication rates of arterio-venous fistula (AVF) constructed in pre-dialysis versus post-dialysis settings.
OBJECTIVES
To determine the difference in patency and complication rates of arterio-venous fistula (AVF) constructed in pre-dialysis versus post-dialysis settings.
STUDY DESIGN
Descriptive study.
PLACE AND DURATION OF STUDY
The Department of Vascular Surgery, Shifa International Hospital, Islamabad from January 2014 to August 2020.
METHODOLOGY
Computerised record of 726 patients, who had undergone vascular access surgery for haemodialysis, was collected. Patients were divided into two groups according to those who had undergone AVF surgery: a) prior to the commencement; or b) after the commencement of haemodialysis. Primary and secondary patency rates were determined clinically by using duplex scans. Complications and suitability of AV fistula were assessed in both the groups. Data was collected and analysed using SPSS version 25, considering p-value of less than 0.05 as statistically significant.
RESULTS
Early fistula failure was significantly higher in post-dialysis group compared with pre-dialysis group, while primary patency was higher in pre-dialysis (78.2%) group comparing with post-dialysis (66.1%) group. Secondary patency was 88.9% and 75.8% in pre- and post-dialysis groups, respectively. Early dialysis suitability failure rates were 12.2% and 15.1%; and late suitability failure rates were 7.9% and 16.1% in the pre- and post-dialysis groups, respectively. Higher rates of complications like maturation failure, low flow AVF, stenosis, thrombosis, venous hypertension, AV aneurysm, and infections were encountered in post-dialysis group compared to pre-dialysis group.
CONCLUSION
Surgical creation of AVF three months prior to commencement of haemodialysis is advantageous in terms of patient outcomes and healthcare resources. However, a multidisciplinary approach and timely referral of patients to a vascular clinic further enhances the outcome with respect to the suitability of vascular access for dialysis.
KEY WORDS
Arterio-venous fistula, Dialysis, Patency, Complications, Suitability.
Topics: Arteriovenous Fistula; Arteriovenous Shunt, Surgical; Dialysis; Humans; Kidney Failure, Chronic; Renal Dialysis
PubMed: 35330526
DOI: 10.29271/jcpsp.2022.04.510