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SYMPTOMATIC HIGH FLOW ARTERIOVENOUS FISTULA OF THE LOWER EXTREMITY IN AN ADULT WITH NO HISTORY OF TRAUMA
Eric Trestman, M.D., John Phair, MD, Ratna Medicherla, MD, Jennifer Stableford, MD.
Montefiore Medical Center, Bronx, NY, USA.
OBJECTIVES–
To report a symptomatic high output arteriovenous fistula of the left lower extremity with no history of trauma successfully treated conservatively with compression therapy.
METHODS–
An extensive literature search was performed using the MEDLINE and Pubmed databases with substantial results in existing literature in regards to symptomatic lower extremity arteriovenous fistulae resulting in high output heart failure. However, the vast majority of these cases are linked to trauma. There are no cases in the current literature describing a massive, likely primary arteriovenous fistula remaining asymptomatic until adulthood.
RESULTS–
Case Report: We report a case of a left common femoral artery common femoral vein arteriovenous fistula found while the patient was undergoing workup of new onset heart failure. High flow arteriovenous fistula of the lower extremity, particularly cases which involve the patient becoming symptomatic in adulthood are the result of trauma. This is the only case in the current literature of primary arteriovenous fistulae resulting in high output heart failure as an adult. Furthermore, as this patient was a poor operative candidate due to extensive co morbidities and the lesion was not amenable to endovascular repair, we attempted the novel approach of using conservative compression therapy in this setting which yielded substantial relief of the patients symptoms of high outflow heart failure and lower extremity swelling.
CONCLUSIONS–
This is case represents the rare entity of a primary high flow arteriovenous fistula which became symptomatic well into adulthood. High output heart failure is a well-documented and described sequelae of post-traumatic arteriovenous fistulae. This case may represent a number of undiagnosed arteriovenous malformation which remain largely asymptomatic. Furthermore, this case illuminates an alternative to invasive treatment of these complex lesions in patients who may not be able to tolerate open surgery and whose lesions are not amenable to endovascular intervention.
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