eMedicine Specialties > Vascular Surgery > Medical Topics

Arteriovenous Fistulas: Follow-up

Author: Igor A Laskowski, MD, Assistant Professor of Surgery, Section of Vascular Surgery, New York Medical College, Westchester Medical Center
Coauthor(s): Sateesh C Babu, MD, Professor of Clinical Surgery, New York Medical College; Associate Director, Vascular Surgery, Co-chief Endovascular Surgery, Westchester Medical Center, Valhalla NY; Mark D Morasch, MD, Clinical Practice Director, Division of Vascular Surgery, Assistant Professor of Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine; Dipen Maun, MD, Staff Physician, Department of Surgery, Mount Sinai School of Medicine
Contributor Information and Disclosures

Updated: Dec 15, 2008

Follow-up

Complications

Except for very small arteriovenous fistulas (AVFs), all other acquired arteriovenous fistulas (AVFs) need to be treated to prevent complications of distal limb ischemia, continued large flow of blood with eventual heart failure, and rarely infection, such as endocarditis. Recurrence is a complication of inadequate or incomplete treatment.

Prognosis

  • Recent advancements in the diagnosis and treatment of arteriovenous malformations are promising. These advancements provide hope to patients who are affected by this sometimes debilitating disease. In acquired arteriovenous fistulas (AVFs), prognosis is excellent once the arteriovenous fistula (AVF) is corrected.
  • Yakes et al obtained follow-up studies in 19 of 20 patients with AVMs treated with ethanol embolization.10 All patients showed persistent occlusion of the malformation radiographically after as long as 24 months of follow-up. Widlus et al treated 11 patients with cyanoacrylate embolization. During a 40-month follow-up period, 82% reported complete resolution of their symptoms and the remaining patients showed improvement. No patients reported worsening of their symptoms with embolization in these 2 series.11
  • In 1992, Pearce reported experience in 15 patients with vascular malformations treated surgically. Five patients were lost to follow-up. Assuming those patients did well and did not seek further intervention, two thirds of those undergoing excision improved. Thirteen percent were unchanged and 20% were worse after surgical excision.

Patient Education

Physicians have to be aware of the subtle signs of arteriovenous fistula (AVF) to make the correct diagnosis. Prominent veins in the leg in a young individual following trauma, which may be mistakenly diagnosed as simple varicose veins, and rapid onset of heart failure in an otherwise healthy person, which may be diagnosed as cardiomyopathy, are examples for the need to look further for the presence of arteriovenous fistulas (AVFs).

Miscellaneous

Medicolegal Pitfalls

  • Alcohol sclerotherapy may shrink the size of the arteriovenous malformation (AVM), but this treatment also places the patient at risk for peripheral nerve injury. The treatment of large arteriovenous malformations (AVMs) with alcohol needs to be performed by an experienced interventional radiologist, and these risks must be explained to patients when they consent to undergo therapy.
  • Missing the presence of arteriovenous fistula (AVF) after blunt or penetrating trauma is easy, but this condition needs to be looked for. In cases of any gunshot wound or stab wound that traverses the course of a blood vessel, ruling out vascular injury, particularly arteriovenous fistula (AVF), with an imaging study (duplex scan, CT scan, MR angiogram, or even conventional angiogram) is important. Failure to diagnose may have medicolegal implications.
 


More on Arteriovenous Fistulas

Overview: Arteriovenous Fistulas
Differential Diagnoses & Workup: Arteriovenous Fistulas
Treatment & Medication: Arteriovenous Fistulas
Follow-up: Arteriovenous Fistulas
Multimedia: Arteriovenous Fistulas
References
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References

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  2. Brouillard P, Boon LM, Mulliken JB, et al. Mutations in a novel factor, glomulin, are responsible for glomuvenous malformations ("glomangiomas"). Am J Hum Genet. Apr 2002;70(4):866-74. [Medline].

  3. Pearce WH, Rutherford RB, Whitehill TA, et al. Nuclear magnetic resonance imaging: its diagnostic value in patients with congenital vascular malformations of the limbs. J Vasc Surg. Jul 1988;8(1):64-70. [Medline].

  4. Dobson MJ, Hartley RW, Ashleigh R, et al. MR angiography and MR imaging of symptomatic vascular malformations. Clin Radiol. Aug 1997;52(8):595-602. [Medline].

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  8. White RI Jr, Pollak J, Persing J, et al. Long-term outcome of embolotherapy and surgery for high-flow extremity arteriovenous malformations. J Vasc Interv Radiol. Nov-Dec 2000;11(10):1285-95. [Medline].

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  10. Yakes WF, Krauth L, Ecklund J, et al. Ethanol endovascular management of brain arteriovenous malformations: initial results. Neurosurgery. Jun 1997;40(6):1145-52; discussion 1152-4. [Medline].

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  16. Said SA, Landman GH. Coronary-pulmonary fistula: long-term follow-up in operated and non-operated patients. Int J Cardiol. May 1990;27(2):203-10. [Medline].

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Further Reading

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Keywords

arteriovenous fistulas, vascular malformations, arteriovenous fistula, hemangioma, vascular anomalies, angiomas, birthmarks, port-wine stains, AVF, acquired singular communication between an artery and a vein, arteriovenous malformations, AVM, congenital abnormal communication between an artery and a vein, fistula, vascular birthmarks, vascular birthmark

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Contributor Information and Disclosures

Author

Igor A Laskowski, MD, Assistant Professor of Surgery, Section of Vascular Surgery, New York Medical College, Westchester Medical Center
Igor A Laskowski, MD is a member of the following medical societies: American College of Surgeons, American Hepato-Pancreato-Biliary Association, Peripheral Vascular Surgery Society, Society for Vascular Surgery, and Transplantation Society
Disclosure: Nothing to disclose.

Coauthor(s)

Sateesh C Babu, MD, Professor of Clinical Surgery, New York Medical College; Associate Director, Vascular Surgery, Co-chief Endovascular Surgery, Westchester Medical Center, Valhalla NY
Sateesh C Babu, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Institute of Ultrasound in Medicine, American Medical Association, Eastern Vascular Society, International Society of Endovascular Specialists, New York Academy of Sciences, Royal Society of Medicine, Society for Vascular Surgery, and Stroke Council of the American Heart Association
Disclosure: Nothing to disclose.

Mark D Morasch, MD, Clinical Practice Director, Division of Vascular Surgery, Assistant Professor of Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine
Mark D Morasch, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, and Central Surgical Association
Disclosure: Nothing to disclose.

Dipen Maun, MD, Staff Physician, Department of Surgery, Mount Sinai School of Medicine
Dipen Maun, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, and American Medical Student Association/Foundation
Disclosure: Nothing to disclose.

Medical Editor

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Vincent Lopez Rowe, MD, Assistant Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center
Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, Association for Academic Surgery, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, and Society for Vascular Surgery
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

 
 
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