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      Delayed Treatment of Iatrogenic Brachial Arteriovenous Fistula

      case-report

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          Abstract

          Iatrogenic vascular injuries may occur during venipuncture, arterial cannulation, or catheterization procedures. Brachial arteriovenous fistula (AVF) resulting from antecubital vascular access is rare and develops slowly. We report the case of an 18-year-old man who had developed iatrogenic brachial AVF. He had a history of several venipunctures in the left arm at the age of 10 months. Doppler ultrasonography and computed tomographic angiography were used to establish a diagnosis of brachial AVF, and surgical correction of the AVF was performed. As our case indicates, delayed surgery can be considered as a treatment option and may be associated with a decreased risk of vascular complications in the management of iatrogenic brachial AVF in infants.

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          Incidence and clinical outcome of iatrogenic femoral arteriovenous fistulas: implications for risk stratification and treatment.

          Christian Perings, Bodo E Strauer, Matthias P Heintzen … (2002)
          We sought to determine the incidence of arteriovenous fistulas (AVF), identify risk factors for AVF, and follow up the clinical outcome of femoral AVF. Arteriovenous fistulas are a potential harmful complication of cardiac catheterization. Incidence and clinical outcome of iatrogenic AVF are unknown so far, although important for risk stratification and treatment. A total of 10,271 consecutive patients undergoing cardiac catheterization were followed up prospectively over a period of three years. Diagnosis of AVF was performed by duplex sonography. The incidence of AVF was 0.86% (n = 88). The following significant and independent risk factors for AVF were identified: high heparin dosage (odds ratio [OR]) = 2.88), coumadin therapy (OR = 2.34), puncture of the left groin (OR = 2.21), arterial hypertension (OR = 1.86), and female gender (OR = 1.84). Within 12 months 38% of all AVF closed spontaneously. No signs of cardiac volume overload or limb damage were observed in patients with persisting AVF. None of the risk factors for AVF influenced the incidence or the rate of AVF closure. Only intensified anticoagulation showed a tendency to extend AVF persistence. Almost 1% of patients undergoing cardiac catheterization acquire femoral AVF, for which patient- and procedure-related risk factors could be identified. One-third of iatrogenic AVF close spontaneously within one year. Cardiac volume overload and limb damage are highly unlikely with AVF persistence. Thus, a conservative management for at least one year seems to be justified.
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            Iatrogenic brachial arteriovenous fistula in a child: color Doppler ultrasonographic evaluation.

            Stylianos D Megremis, Nikolaos Mourkoyiannis, S Papadopoulos … (2006)
            Article 0 comments Cited 5 times – based on 0 reviews     Review now
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              Pseudoaneurysms of the brachial artery following venipuncture in infants.

              Ivo Dzepina, Josip Unusic, Davor Mijatovic … (2004)
              Pediatric vascular injuries are increasing in frequency and represent a challenging problem in pediatric surgical practice. Increased survival of low birth weight infants and advances in invasive diagnostic procedures have resulted in a dramatic increase in the number of these injuries. Formation of pseudoaneurysm of the brachial artery in infants is a very rare complication of venipuncture, with only two cases reported in the literature. We report three cases of brachial artery pseudoaneurysm in infants following venipuncture who were operated upon in our institution, aged 43-64 days at the time of operation. The period from the injury to the operation ranged from 25 to 42 days. All three infants were referred from different institutions. In two infants, the pseudoaneurysms and the involved part of the artery were resected, and arterial continuity was restored with an end-to-end anastomosis; in the other infant, reconstruction was done using a venous interposition graft. All three infants were diagnosed with duplex ultrasonography, and the child requiring a more complex reconstructive procedure was also evaluated with helical contrast computed tomography. Brachial artery pseudoaneurysms are a rare but possible complication of multiple venipuncture in infants. Early diagnosis and microvascular reconstruction are key points in managing these injuries.
              Article 0 comments Cited 4 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Thorac Cardiovasc Surg
                Journal ID (iso-abbrev): Korean J Thorac Cardiovasc Surg
                Title: The Korean Journal of Thoracic and Cardiovascular Surgery
                Publisher: The Korean Society for Thoracic and Cardiovascular Surgery
                ISSN (Print): 2233-601X
                ISSN (Electronic): 2093-6516
                Publication date (Print): 5 December 2020
                Publication date (Electronic): 9 September 2020
                Publication date PMC-release: 9 September 2020
                Volume: 53
                Issue: 6
                Pages: 408-410
                Affiliations
                [1]Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
                Author notes
                Corresponding author Chun Sung Byun Tel 82-33-741-1323 Fax 82-33-742-0666 E-mail csbyun@ 123456yonsei.ac.kr ORCID https://orcid.org/0000-0001-5409-6798
                Author information
                https://orcid.org/0000-0003-4694-9206
                https://orcid.org/0000-0001-9818-8379
                https://orcid.org/0000-0001-8155-1880
                https://orcid.org/0000-0001-5409-6798
                Article
                Publisher ID: KJTCV-53-408
                DOI: 10.5090/kjtcs.20.019
                PMC ID: 7721528
                PubMed ID: 32919442
                SO-VID: 83b58b80-fc8d-4973-9ef7-79734dd20705
                Copyright © Copyright © The Korean Society for Thoracic and Cardiovascular Surgery. 2020. All right reserved.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 27 March 2020
                Date revision received : 17 May 2020
                Date accepted : 28 May 2020
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: arteriovenous fistula,brachial artery injury,vascular system injury
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: arteriovenous fistula, brachial artery injury, vascular system injury

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