Delayed presentation of an iatrogenic, traumatic brachio-brachial fistula

Abstract

Iatrogenic arteriovenous fistulae are rare occurrences after venepuncture, line placement or trauma. Presentations and symptoms can vary but they are usually identified soon after the causative injury due to the development of a visible, palpable, and pulsatile lump that can be concerning for patients. We describe the presentation and management of an unusual case of delayed presentation of an iatrogenic, traumatic brachio-brachial fistula.

Successful treatment by coil embolization for pediatric brachial arteriovenous fistula: A case report

“…Brachial AVFs in the pediatric population are rare and seldom reported in the literature [ 1 , 2 ]. They can be caused by trauma, needle puncture, or other iatrogenic injury [ [3] , [4] , [5] ]. Most patients remain asymptomatic for several years until local swelling and a palpable lump with a pulsatile thrill become clinically noticeable.…”

“…Conventionally, peripheral AVFs are treated with surgical ligation by vascular surgeons, but endovascular embolization is feasible in selected cases and is being increasingly performed for the treatment of peripheral AVFs [ 2 , 4 , 8 ]. For AVF ligation, surgery at the antecubital fossa carries a risk of inadvertent injury to the surrounding structures, such as the median nerve or normal branches of the brachial artery, during exploration, and the location of the fistula may be difficult to identify, especially in pediatric patients [ 15 ].…”

“…Arteriovenous fistulae (AVFs) of the upper limbs are rarely encountered in children [ 1 , 2 ]. They can be caused by trauma, needle puncture, or other iatrogenic injuries [ [3] , [4] , [5] ]. The most common presenting symptom is a palpable lump with a pulsatile thrill, especially in patients with longstanding diseases [ 1 , 2 ].…”

“…Accurate diagnosis and localization of the fistulous point are important, and differential diagnosis with other vascular lesions, such as arteriovenous malformation (AVM) or hemangioma, is critical because the treatment methods and potential complications differ between these entities [ 6 , 7 ]. Conventionally, AVFs of the upper limbs are treated with surgical ligation, but endovascular embolization is also feasible in selected cases and is being increasingly performed to treat peripheral AVFs [ 2 , 4 , 8 ].…”

Iatrogenic arteriovenous fistula in the brachial artery after percutaneous coronary intervention in a patient with end stage kidney disease

“…4 Iatrogenic AVF is one of complications that accompanies venous and arterial puncture, and mainly occurs at the level of the femoral access. Iatrogenic AVF in the brachial artery is not rare, 5,6 Iatrogenic arteriovenous fistula in the brachial artery after percutaneous coronary intervention in a patient with end stage kidney disease but it tends to close spontaneously and disappear within a few years of its onset. 7 Therefore, few previous reports exist on the presence of iatrogenic AVF in the brachial artery.…”