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AV fistula

From Surgopaedia

Aetiology

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  • Trauma
  • Iatrogenic - percutaneous access

Risk factors

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  • Anticoagulation
  • Female
  • HTN
  • Left groin puncture

Clinical presentation

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  • Palpable thrill/bruit
  • Pulsatile mass
  • Steal syndrome
  • High-output heart failure - shunting

Treatment

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  • Indications
    • Symptomatic
    • Haemodynamic instability
    • Failure to self-resolve
  • Ligation of fistula
    • Proximal and distal control
    • Dividing fistulous channel
    • Primary repair of arterial/venous defects using polypropylene suture
  • Endovascular repair is generally not appropriate because of concerns with stent durability, if the AV fistula is in an area of flexion
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