Dr.Derar Ismael Ismirat

2. Arterio-Venous Fistula
By
Mounir K. Mabrouk
Professor of Vascular Surgery
Alexandria University

3. 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:

4. 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.

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7. Arterio-Venous Fistula

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9. Arterio-Venous Fistula
I. Congenital:
2. Macroscopic: (Parks Weber syndrome)
- Positive thrill
- Positive machinery murmur
- Usually in hands or feet
- Usually multiple arterial feeders

10. Arterio-Venous Fistula

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12. Arterio-Venous Fistula

13. Arterio-Venous Fistula

14. 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.

15. Arterio-Venous Fistula
III. Iatrogenic:
- During femoral cannulation
- Screws injuries for fracture fixation
- During laminectomy

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17. Arterio-Venous Fistula

18. Arterio-Venous Fistula
IV. Vascular access for chronic
hemodialysis in ESRD

19. Arterio-Venous Fistula
V. Rupture of aneurysm into a
neighboring vein
- As in aorto-caval fistula after AAA rupture into the
cava.

20. Arterio-Venous Fistula
Manifestations of macroscopic AVF
Local:
- Pulsating warm mass
- Varicose veins
- Thrill
- Machinery murmur

21. 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)

22. 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.

23. 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.

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29. Arterio-Venous Fistula
Management of AVF
Microscopic:
- Mainly conservative
Elastic stocking
Incompetent perforator ligation or
sclerotherapy
Laser for bleeding superfacial angiomas

30. 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.

34. Data show design & preparation by :
Dr. El-Sayed Amr - (012) 3106023