Disease: Arteriovenous fistula

Overview

An arteriovenous (AV) fistula is an abnormal connection between an artery and a vein. Normally, blood flows from your arteries to your capillaries to your veins. Nutrients and oxygen in your blood travel from your capillaries to tissues in your body.

With an arteriovenous fistula, blood flows directly from an artery into a vein, bypassing some capillaries. When this happens, tissues below the bypassed capillaries receive a diminished blood supply.

Arteriovenous fistulas usually occur in the legs, but can develop anywhere in the body. Arteriovenous fistulas are often surgically created for use in dialysis in people with severe kidney disease.

A large untreated arteriovenous fistula can lead to serious complications. Your doctor monitors your arteriovenous fistula if you have one for dialysis.

Source: http://www.mayoclinic.com

Symptoms

Small arteriovenous fistulas in your legs, arms, lungs, kidneys or brain often won't have any signs or symptoms and usually don't need treatment other than monitoring by your doctor. Large arteriovenous fistulas may cause signs and symptoms.

Arteriovenous fistula signs and symptoms may include:

  • Purplish, bulging veins that you can see through your skin, similar to varicose veins
  • Swelling in the arms or legs
  • Decreased blood pressure
  • Fatigue
  • Heart failure

An arteriovenous fistula in your lungs (pulmonary arteriovenous fistula) is a serious condition and can cause:

  • A bluish tinge to the skin
  • Clubbing of fingers
  • Coughing up blood

An arteriovenous fistula in your gastrointestinal tract can cause bleeding in your digestive tract.

When to see a doctor

If you have any of these signs and symptoms and think you might have an arteriovenous fistula, make an appointment to see your doctor. Early detection of an arteriovenous fistula may make your condition easier to treat and may reduce your risk of developing complications, such as blood clots or, in severe cases, heart failure.

Source: http://www.mayoclinic.com

Causes

Causes of arteriovenous fistulas include:

  • Cardiac catheterization. An arteriovenous fistula may develop as a complication of a procedure called cardiac catheterization. During cardiac catheterization, a long, thin tube called a catheter is inserted in an artery or vein in your groin, neck or arm and threaded through your blood vessels to your heart.

  • If the needle used in the catheterization crosses an artery and vein during your procedure, and the artery is widened (dilated), this can create an arteriovenous fistula. This rarely happens.

  • Injuries that pierce the skin. It's also possible to develop an arteriovenous fistula after a piercing injury, such as a gunshot or stab wound. This may happen if your wound is on a part of your body where a vein and artery are side by side.
  • Being born with an arteriovenous fistula. Some people are born with an arteriovenous fistula (congenital). Although the exact reason why isn't clear, in congenital arteriovenous fistulas the arteries and veins don't develop properly in the womb.
  • Genetic conditions. Arteriovenous fistulas in the lungs (pulmonary arteriovenous fistulas) can be caused by a genetic disease (Osler-Weber-Rendu disease, also known as hereditary hemorrhagic telangiectasia) that causes blood vessels to develop abnormally throughout your body, but especially in the lungs.
  • Surgical creation (AV fistula procedure). People who have late-stage kidney failure may have an arteriovenous fistula surgically created to make it easier to perform dialysis. If a dialysis needle is inserted into a vein too many times, the vein may scar and be destroyed.

    Creating an arteriovenous fistula widens the vein by connecting it to a nearby artery, making it easier to insert a needle for dialysis and causing blood to flow faster. This AV fistula is usually created in the forearm.

Source: http://www.mayoclinic.com

Diagnosis

To diagnose an arteriovenous fistula in your arms or legs, your doctor will use a stethoscope to listen to the blood flow through the area where he or she thinks you may have a fistula. The blood flow through an arteriovenous fistula makes a sound similar to clicking or humming machinery (machinery murmur).

If your doctor suspects a fistula, you'll have other tests to confirm your diagnosis. These can include:

  • Duplex ultrasound. Duplex ultrasound is the most effective and common way to check for an arteriovenous fistula in the blood vessels of your legs or arms. In duplex ultrasound, an instrument called a transducer is pressed against your skin over the suspicious area.

    The transducer produces high-frequency sound waves, which bounce off red blood cells. A duplex ultrasound can estimate how fast blood flows by measuring the rate of change in its pitch (frequency).

  • Computerized tomography (CT) angiogram. A CT angiogram allows your doctor to check your arteries to see if blood flow is bypassing the capillaries. You'll receive an injection of a dye that shows up on CT images, and the doughnut-shaped CT scanner will be moved to take images of the artery your doctor believes is narrowed. The images are then sent to a computer screen for your doctor to view.
  • Magnetic resonance angiography (MRA). Your doctor may use an MRA if he or she thinks you may have an arteriovenous fistula in an artery that's deep under your skin. This test allows your doctor to see the soft tissues in your body. It uses the same technique as magnetic resonance imaging (MRI), but also includes the use of a special dye that helps create images of your blood vessels.

    During an MRI or MRA, you lie on a table inside a long tubelike machine that produces a magnetic field. An MRI machine uses the magnetic field and radio waves to create pictures of your body's tissues. Using the images from the test, your doctor may be able to see an arteriovenous fistula.

Source: http://www.mayoclinic.com

Complications

Left untreated, an arteriovenous fistula can cause complications, some of which can be serious. These include:

  • Heart failure. This is the most serious complication of large arteriovenous fistulas. Since your blood flows more quickly through an arteriovenous fistula than it would if your blood flowed through a normal course of arteries, capillaries and veins, your heart pumps harder to compensate for the drop in blood pressure (called high-output heart failure). Over time, the increased intensity of your heart's pumping can weaken your heart muscle, leading to heart failure.
  • Blood clots. An arteriovenous fistula in your legs can cause blood clots to form, potentially leading to deep vein thrombosis, a painful and potentially life-threatening condition if the clot travels to your lungs (pulmonary embolism). Depending on where your fistula is, it can lead to a stroke.
  • Leg pain. An arteriovenous fistula in your leg can also cause you to develop pain in your legs (claudication), or can worsen pain you already have.
  • Bleeding. Arteriovenous malformations may lead to bleeding, including into your gastrointestinal system.

Source: http://www.mayoclinic.com

Risk factors

Beyond genetic or congenital conditions, your risk of developing an arteriovenous fistula may increase due to certain factors, including:

  • Cardiac catheterization, especially if the procedure involves blood vessels in your groin
  • High blood pressure (hypertension)
  • High body mass index (BMI)
  • Certain medications, including some blood thinners (anticoagulants) and medications used to control bleeding (anti-fibrinolytics)
  • Older age
  • Being female

Source: http://www.mayoclinic.com

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