Post-Traumatic Arteriovenous Fistulas Leading to Heart Failure

Abstract

Introduction The detection of acquired arteriovenous fistulas (AVFs) is mostly incidental. However, the modification of haemodynamic conditions secondary to AVFs can lead to dramatic systemic complications, including cardiac complications. In this report, two unusual cases of congestive heart failure secondary to acquired AVF are presented. Report A 40 year old man with past history of gunshot wound of the right flank complained of severe right limb swelling and shortness of breath. An AVF between the right external iliac artery and external iliac vein responsible for the cardiac failure was diagnosed. A 40 year old woman with past history of spinal surgery complained of breathlessness and lower limb oedema. She presented with recurrent episodes of ascites and dyspnoea. An AVF between the right common iliac artery and the common iliac vein responsible for high output cardiac failure was diagnosed. Open surgery was performed in both patients and treatment of the AVFs led to the resolution of all symptoms. Follow up at four and three years, respectively, was uneventful in both cases. Discussion Although rare, heart failure secondary to an AVF can be encountered. These rare cases highlight the significance of careful inquiry into the patient's medical history and meticulous follow up physical examinations for patients with injuries in close proximity to vessels.

El inesperado diagnóstico de una fístula arteriovenosa traumática en vasos ilíacos. Presentación de caso

“…Dependiendo de la localización y diámetro de los vasos involucrados se pueden producir alteraciones sistémicas importantes (2). En la mayoría de los casos no existe al inicio una sintomatología clara y específica que permita identificar tempranamente esta entidad, por lo cual un gran porcentaje de pacientes que cursan con esta patología se diagnostican tardíamente, lo que conlleva a que en el momento del diagnóstico haya algunas complicaciones hemodinámicas asociadas a la cronificación de las fístulas, como la insuficiencia cardiaca (IC) (1)(2)(3)(4). Es importante su sospecha clínica temprana y la detección de los signos tomográficos con el fin de prevenir las consecuencias relacionadas con el diagnóstico tardío (4,5).…”