Arterio venous fistula

Highlights :

Arterio venous fistula

Written by Administrator

Thursday, 22 October 2009 08:44

ARTERIO-VENOUS FISTULA

Aetiology:
(1) Congenital 5% it is usually microscopical and leads to local gigantism.
(2) Traumatic 9%.

(3) Therapeutic fistula is done for haemodialysis purposes.
(4) Latrogenic fistula follow transfixed ligation of vascular pedicles.
Clinical Picture:
1- Local features:  Pulsating mass.  Machinery murmur.
 Thrill. 2ry varicose vein.
2- General features:
 Hyperdynamic circulation with water hammer pulse.
 Thrill on palpation maximum at the AV communication.
 Systolic murmur.
 Tachycardia but if the fistula is closed by finger compression this will lead to bradycardia (Branham's sign).
 Distal features of ischaemia due to steal phenomenon and V.V.
Diagnosis:
 Branham's sign.
 Digital subtraction angiography  Presence of the vein in arterial phase.
Treatment:
 Excision of the fistula with repair of A.& V. [the best].
 Repair of the artery on expense of the vein.
 Quadrible ligations.
SOURCE: DR AYMAN SALEM'S BOOK