[Cardiology] Iatrogenic AVF(AV fistula) after cardiac cath / EP procedure. (topic review)

[Category] Topic; 1. Workup; 2. Management; 3. Tip and Teaching point; 4. References;

Definition: anomalous connections between the arterial and venous system.

m/c location: lower extremity

Risk factors: old, female, obesity, HTN

                     below the common femoral arteries, multiple puncture, Lt. puncture, multiple punctures, 

                     Sheath placement

Incidence: 0.01 - 0.9% in percutaneous groin access => after intervention, needs to check groin(evaluate with palpation, thrill, auscultation), peripheral pulses(adequacy of the pulses), warmth

History: 2 days to several months to form AVF (cf. pseudoaneurysm: right away upto 10 days)

             

Sx. Fatigue, new HF,

      Vibration in the groin, Lower extremity ischemic symptom(claudication), edema, 

Cx. DVT, nerve compression, worsening varicose vein

Dx. 

ABI(for evaluation of peripheral ischemia) 

Duplex USG(high frequency, low risistance flow with continuous flow and elevated diastolic velocities through the pulse cycle; mosaic pattern) 

Tx. compression(manual or USG guided)

      surgery(with sx = claudication, ischemia, edema, venous insufficiency, CHF; and iatrogenic) 

Px. f/u 3 weeks -> 80% spontaneously resolved good. 

      persist -> USG compression -> 1/3 resolved

      persist -> surgery(1st) -> endovascular procedure(stent, 2nd)