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Dr.Derar Ismael Ismirat

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  1. 1. Arterio-Venous Fistula By Mounir K. Mabrouk Professor of Vascular Surgery Alexandria University
  2. 2. Arterio-Venous Fistula Abnormal communication between arteries and veins Definition: I. Congenital II. Traumatic III. Iatrogenic IV.Chronic hemodialysis vascular access V. Rupture of aneurysm into a vein Types:
  3. 3. Arterio-Venous Fistula I. Congenital: 1. Microscopic: (Klipple-Trenaunay syndrome) Associated with: - Cutaneous salmon pink or port-wine angiomas - Possible gigantism of a limb - Edema, chronic venous insufficiency skin changes. - Sometimes large lateral vein(s) - Possible aplasia of deep venous system - Possible bone deformities - No thrill, no machinery murmur.
  4. 4. Arterio-Venous Fistula
  5. 5. Arterio-Venous Fistula
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  8. 8. Arterio-Venous Fistula I. Congenital: 2. Macroscopic: (Parks Weber syndrome) - Positive thrill - Positive machinery murmur - Usually in hands or feet - Usually multiple arterial feeders
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  10. 10. Arterio-Venous Fistula
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  13. 13. Arterio-Venous Fistula II. Traumatic: - By sharp or pointed object stab causing incomplete injury of lateral wall of both artery and vein. - Can be acute or chronic.
  14. 14. Arterio-Venous Fistula III. Iatrogenic: - During femoral cannulation - Screws injuries for fracture fixation - During laminectomy
  15. 15. Arterio-Venous Fistula
  16. 16. Arterio-Venous Fistula
  17. 17. Arterio-Venous Fistula IV. Vascular access for chronic hemodialysis in ESRD
  18. 18. Arterio-Venous Fistula V. Rupture of aneurysm into a neighboring vein - As in aorto-caval fistula after AAA rupture into the cava.
  19. 19. Arterio-Venous Fistula Manifestations of macroscopic AVF Local: - Pulsating warm mass - Varicose veins - Thrill - Machinery murmur
  20. 20. Arterio-Venous Fistula Manifestations of macroscopic AVF Proximal: - Nicoladoni-Branham sign Diminished heart rate after temporary closure of A- V fistula by digital compression due to diminished venous return (Bainbridge reflex)
  21. 21. Arterio-Venous Fistula Manifestations of macroscopic AVF Proximal: - Induced heart failure in borderline cardiac patients. - High output heart failure with large fistulas even in non-cardiac patients.
  22. 22. Arterio-Venous Fistula Manifestations of macroscopic AVF Distal: - Diminished arterial supply which may cause distal ischemia (steal phenomenon) - Increased venous congestion, edema, chronic venous insufficiency skin changes.
  23. 23. Arterio-Venous Fistula
  24. 24. Arterio-Venous Fistula
  25. 25. Arterio-Venous Fistula
  26. 26. Arterio-Venous Fistula
  27. 27. Arterio-Venous Fistula
  28. 28. Arterio-Venous Fistula Management of AVF Microscopic: - Mainly conservative Elastic stocking Incompetent perforator ligation or sclerotherapy Laser for bleeding superfacial angiomas
  29. 29. Arterio-Venous Fistula Management of AVF Macroscopic: - Surgical separation and lateral repair of both artery and vein. - Endovascular repair : - Using stented graft inserted into the artery to exclude the fistula’s tract. Embolization therapy: Macroscopic congenital types, internal organs, brain. Metal coils, glue can be used.
  30. 30. Data show design & preparation by : Dr. El-Sayed Amr - (012) 3106023

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