Closure of arteriovenous fistulae and malformations
Summary
Arteriovenous (AV) fistulae are abnormal connections between arteries and veins bypassing interposed arterioles, capillaries and venules. The occurrence and type of clinical manifestations and treatments for AV fistulae depend on the fistula size and vascular territory involved. Frequently, AV fistulae do not require percutaneous or surgical intervention. When treatment is indicated, provided it is technically feasible, percutaneous intervention is the preferred approach. Methods and equipment depend on the fistula size and location. The following chapter aims to provide an overview of the most commonly encountered fistulae, including clinical manifestations and treatment.
Introduction
An arteriovenous (AV) fistula is an abnormal connection between an artery and a vein bypassing interposed arterioles, capillaries and venules. This typically causes dilatation of the veins it feeds due to transmission of arterial pressure to the venous system. AV fistulae are rare and can be inherited (congenital), or acquired. Acquired fistulae are the consequence of trauma, erosion of an aneurysmal artery into a vein or iatrogenic (e.g., related to arterial and venous puncture for the purpose of catheterisation or to surgical creation of an arteriovenous connection to facilitate haemodialysis). General pathophysiological concepts which apply to any arteriovenous fistula are ischaemia in the territory supplied by the feeding artery...
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- Qureshi SA. Coronary arterial fistulas. Orphanet J Rare Dis. 2006;1:51.
- Levin DC, Fellows KE, Abrams HL. Hemodynamically significant primary anomalies of the coronary arteries. Angiographic aspects. Circulation. 1978;58:25-34.
- Sen S, Chattopadhyay A, Ray M, Bandyopadhyay B. Transcatheter device closure of ruptured sinus of Valsalva: Immediate results and short term follow up. Ann Pediatr Cardiol. 2009;2:79-82.
- Faughnan ME, Granton JT, Young LH. The pulmonary vascular complications of hereditary haemorrhagic telangiectasia. Eur Respir J. 2009;33:1186-94.
- Mager JJ, Overtoom TT, Blauw H, Lammers JW, Westermann CJ. Embolotherapy of pulmonary arteriovenous malformations: long-term results in 112 patients. J Vasc Interv Radiol. 2004;15:451-6.
- Faughnan ME, Palda VA, Garcia-Tsao G, Geisthoff UW, McDonald J, Proctor DD, Spears J, Brown DH, Buscarini E, Chesnutt MS, Cottin V, Ganguly A, Gossage JR, Guttmacher AE, Hyland RH, Kennedy SJ, Korzenik J, Mager JJ, Ozanne AP, Piccirillo JF, Picus D, Plauchu H, Porteous ME, Pyeritz RE, Ross DA, Sabba C, Swanson K, Terry P, Wallace MC, Westermann CJ, White RI, Young LH, Zarrabeitia R. International guidelines for the diagnosis and management of hereditary hemorrhagic telangiectasia. J Med Genet. 2011;48:73-87.
- Vauthey JN, Tomczak RJ, Helmberger T, Gertsch P, Forsmark C, Caridi J, Reed A, Langham MR Jr, Lauwers GY, Goffette P, Lerut J. The arterioportal fistula syndrome: clinicopathologic features, diagnosis, and therapy. Gastroenterology. 1997;113: 1390-401.
- Chavan A, Caselitz M, Gratz KF, Lotz J, Kirchhoff T, Piso P, Wagner S, Manns M, Galanski M. Hepatic artery embolization for treatment of patients with hereditary hemorrhagic telangiectasia and symptomatic hepatic vascular malformations. Eur Radiol. 2004;14:2079-85.
- Kelm M, Perings SM, Jax T, Lauer T, Schoebel FC, Heintzen MP, Perings C, Strauer BE. Incidence and clinical outcome of iatrogenic femoral arteriovenous fistulas: implications for risk stratification and treatment. J Am Coll Cardiol. 2002;40:291-7.
- Mordasini P, Szucs-Farkas Z, Do DD, Gralla J, Kettenbach J, Hoppe H. Use of a latest-generation vascular plug for peripheral vascular embolization with use of a diagnostic catheter: preliminary clinical experience. J Vasc Interv Radiol. 2010;21:1185-90.