Chronic leg swelling and palpitation as a late complication of post-traumatic arteriovenous fistula: A case report

Kalender, Mehmet; Baysal, Ahmet Nihat; Dağlı, Mustafa; Gökmengil, Hayat

doi:10.1016/j.tcr.2016.03.004

Cited by 15 publications

(13 citation statements)

References 9 publications

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“…4 Associated distal ischemia of digits, venous ectasia, and hypertension and congestive heart failure have been described in literature, especially in cases with delayed presentation after trauma. 4 However, no such association was seen in our case. Our patient presented 8 years after trauma with gradually increasing leg swelling.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular Management of Lower Limb Arteriovenous Fistula Presenting 8 Years After Gunshot Injury

Gorsi

Agarwal

Savlania

et al. 2019

Vasc Endovascular Surg

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Trauma is a common cause of arteriovenous fistula resulting from iatrogenic or penetrating injuries such as gunshot wounds, stab injuries, and so on. Endovascular management using stent grafts is a minimally invasive method to manage these complex vascular injuries. We present a case report of a young male patient who presented to us with complaint of progressively increasing swelling in the left lower limb 8 years after gunshot injury to that limb. Stent grafts were deployed to reconstruct the artery and to occlude the fistulous site.

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Section: Discussionmentioning

confidence: 99%

“…Computed tomography to angiography can help confirm the findings with localization of exact site of fistula with some information on the hemodynamics of the fistula. 4,5 Digital subtraction angiography is the gold standard for diagnosis as well as the management of these lesions. 3,6…”

Section: Discussionmentioning

confidence: 99%

Endovascular Management of Lower Limb Arteriovenous Fistula Presenting 8 Years After Gunshot Injury

Gorsi

Agarwal

Savlania

et al. 2019

Vasc Endovascular Surg

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“…Prolonged exposure to increased blood flow induces change in the vascular wall by precipitating damage to elastic fibers, which leads to further dilatation and increases shunt flow. Excessive blood flow through an AVF may lead to volume overload-induced cardiac remodeling, ventricular dilatation, and congestive heart failure [15–17]. Coexistence of AVF with intraseptal puncture using a wide sheath of over 14 Fr may result in IASD.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Arteriovenous Fistula and Atrial Septal Defect Following Cryoballoon Ablation for Atrial Fibrillation – Two Correctable Causes of Right Heart Failure

et al. 2019

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Patient: Female, 61 Final Diagnosis: Iatrogenic arteriovenous fistula and atrial septal defect following cryoballoon ablation for atrial fibrillation Symptoms: Exercise intolerance • exertional dyspnea • peripheral edema Medication: — Clinical Procedure: Catheter ablation for persistent atrial fibrillation, corrective surgery for arteriovenous fistula Specialty: Cardiology Objective: Diagnostic/therapeutic accidents Background: Catheter ablation for atrial fibrillation is an important therapeutic intervention. One of the most frequent complications of this procedure is vascular issues including arteriovenous fistula. Iatrogenic atrial septal defect (IASD) has been reported as a complication of transseptal puncture; however, no data are available demonstrating any coexistent of arteriovenous fistula with IASD. Case Report: A 61-year-old female patient was admitted to our center for catheter ablation for persistent atrial fibrillation. Her past medical history was significant for cryoballoon ablation for atrial fibrillation in 2015, which was subsequently complicated by hematoma and arteriovenous fistula at puncture site. After general surgery consultation, the patient was qualified for conservative treatment. To exclude left atrial thrombus before redo procedure, transesophageal echocardiography was performed which visualized the presence of 9-mm atrial septal defect with left-to-right shunting, detecting right-to-left shunting using Valsalva maneuver. No significant valvular abnormalities were identified. The next day, pulmonary vein isolation for atrial fibrillation was performed. One month later, a control transthoracic echocardiogram (TTE) revealed hemodynamic significant left-to-right shunting with Qp/Qs 2.0 and high probability of pulmonary hypertension. Vascular surgery for arteriovenous fistula was successfully performed in October 2018. Subsequent TTE, performed a month later, confirmed no left-to-right shunting and no signs of pulmonary hypertension or diminishment of the right atrium. Conclusions: Vascular access during catheter ablation for atrial fibrillation may result in arteriovenous fistula. This condition might affect right atrium pressure leading to increased diameter of previous puncture site at the interatrial septum, causing IASD with significant shunting. In this group of patients, arteriovenous fistula should be treated as soon as possible.

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“…As a late complication of vascular injury, chronic post-traumatic arteriovenous fistula may present with symptoms of venous hypertension and distal ischemia. 14 Three case reports published in 2008 and 2015 described arteriovenous fistulas, as well as pseudoaneurysms of the popliteal artery and intravenous thrombophlebitis, that developed after acupuncture needling in the region of the popliteal artery; two of these procedures were performed by unauthorized practitioners using 3-4 cm acupuncture needles in the popliteal cavity. 15,16 The records in ancient books Ancient acupuncturists also took seriously the risk of severe side effects of deep needling at BL40.…”

Section: Vascular Lesions Following Acupuncturementioning

confidence: 99%

Magnetic resonance imaging study of safe needling depth and angulation for acupuncture at BL40

2020

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Objectives: The objectives of this study were to identify the mean safe needling depth and angle at BL40 between subjects, taking into account variables including sex and body mass index (BMI). Methods: One hundred and twenty-four participants who had undergone magnetic resonance imaging (MRI) examination of the knee region for clinical indications were included in this study. BL40 needling sites were localized by World Health Organization (WHO) standards and were measured by MRI. As much as 70% of the value of AN (from the needle insertion point to the popliteal artery) was considered to represent the safe depth, and angle alpha between the BL40 straight line and the AN line was regarded as the safe angle. Results: Overall, mean safe depth regardless of BMI and sex was 18.51 ± 3.56 mm (95% confidence interval (CI), 17.88%–19.14%). Mean safe depth was 17.24 ± 3.14 mm in the low and normal BMI group, 18.76 ± 2.90 mm in the overweight group, and 22.01 ± 3.71 mm in the obese group. Thirteen patients (10.5%) had internal deviation of angle alpha (95% CI, 5.6%–15.3%), while 111 patients (89.5%) had external deviation (95% CI, 84.7%–94.4%). The mean internal and external deviations of angle alpha were 8.78° ± 2.92° (95% CI, 7.01°–10.55°) and 9.75° ± 3.46° (95% CI, 9.10°–10.41°), respectively. Conclusion: We would suggest that, when using a straight needle insertion at BL40, it is safe to advance a 25-mm needle approximately 12.5 mm, and 17.5 mm should be safe for patients with BMI greater than 28 kg/m2. Practitioners should decrease the depth of penetration when treating patients of low body weight or height.

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Chronic leg swelling and palpitation as a late complication of post-traumatic arteriovenous fistula: A case report

Cited by 15 publications

References 9 publications

Endovascular Management of Lower Limb Arteriovenous Fistula Presenting 8 Years After Gunshot Injury

Endovascular Management of Lower Limb Arteriovenous Fistula Presenting 8 Years After Gunshot Injury

Iatrogenic Arteriovenous Fistula and Atrial Septal Defect Following Cryoballoon Ablation for Atrial Fibrillation – Two Correctable Causes of Right Heart Failure

Magnetic resonance imaging study of safe needling depth and angulation for acupuncture at BL40

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