Iatrogenic arteriovenous fistulas usually occur following
percutaneous interventions, surgical operations, and
trauma. They may remain asymptomatic for many
years. Swelling, thrill, and pulse deficit in the limb are
the clinical features of the fistula.[
2] Peripheral AVFs
may also cause intermittent claudication or venous
hypertension. Progressive symptoms of heart failure
may be also seen eventually.
The diagnosis of AVFs can be made by history
and physical examination.[3] Duplex ultrasonography,
computed tomography, magnetic resonance
imagining, and conventional angiography may be
used to find the localization of the fistula.[4] Colorcoded
Doppler ultrasound is also a non-invasive and
simple method, but in our case this method failed to
show the AVF.
One-third of all AVFs close spontaneously in one
year and for asymptomatic AVFs, watch and wait
policy may be used. The type of treatment depends on
the cause, acute or chronic nature, size and location
of the AVF. Pressure with an ultrasound probe can
be applied or bandaging may be done for spontaneous
closing of the fistula.[2]
Endovascular techniques and surgical repair are two
different options in AV fistula treatment. Although
endovascular techniques reduce patient morbidity and hospital stay, surgery is still the gold standard.[2]
Surgical repair offers a 96% chance of closure of the
fistula.[5] Endovascular modalities of treatment include
covered stent implantation, coil embolization and
utilization of glue. Using covered stents is technically
easy, and said to have a high success rate and a low
complication rate.[6,7]
Endoluminal coils can be easily traced through
the high flow fistula and enter the venous circulation.
Therefore, it must be avoided for the treatment of
the AVF.[8] The use of covered stents and stent grafts
in small arteries has a higher risk of thrombosis and
vascular stenosis.[9]
In conclusion venous hypertension and ischemic
complications can be seen in peripheral arteriovenous
fistulas. To avoid vascular stenosis and thrombosis,
distal AVFs must be treated surgically in trauma
patients.
Declaration of conflicting interests
The authors declared no conflicts of interest with
respect to the authorship and/or publication of this
article.
Funding
The authors received no financial support for the
research and/or authorship of this article.