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      Conservative Management of an Iatrogenic Arteriovenous Fistula

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          Background: Arteriovenous fistula is an uncommon complication of central venous catheterization that often requires invasive repair. Case Report: We report the case of an arteriovenous fistula that presented as ongoing pain following removal of a tunneled central venous catheter. The fistula resolved spontaneously following a period of compression and observation. Conclusion: Our study highlights the etiology of this uncommon complication as well as suggesting a role for conservative management.

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          Most cited references 16

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          Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature.

          To evaluate the effect of real-time ultrasound guidance using a regular or Doppler ultrasound technique for placement of central venous catheters. We searched for published and unpublished research using MEDLINE, citation review of relevant primary and review articles, conference abstracts, personal files, and contact with expert informants. From a pool of 208 randomized, controlled trials of venous and arterial catheter management, eight published randomized, controlled trials were identified. In duplicate, independently, we abstracted data on the population, intervention, outcome, and methodologic quality. Ultrasound guidance significantly decreases internal jugular and subclavian catheter placement failure (relative risk 0.32; 95% confidence interval 0.18 to 0.55), decreases complications during catheter placement (relative risk 0.22; 95% confidence interval 0.10 to 0.45), and decreases the need for multiple catheter placement attempts (relative risk 0.60; 95% confidence interval 0.45 to 0.79) when compared with the standard landmark placement technique. When used for vessel location and catheter placement real-time, ultrasound guidance or Doppler ultrasound guidance improves success rates and decreases the complications associated with internal jugular and subclavian venous catheter placement.
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            Ultrasound guidance for placement of central venous catheters

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              A prospective study of the incidence and natural history of femoral vascular complications after percutaneous transluminal coronary angioplasty.

              Over a 14-month period patients undergoing 144 percutaneous transluminal coronary angioplasty procedures were evaluated for the presence of complications at the femoral puncture site. After percutaneous transluminal coronary angioplasty each patient was examined by a surgeon, and then a color-flow duplex scan of the groin was obtained. On the initial scan eight pseudoaneurysms, three arteriovenous fistulas, one combined arteriovenous fistula-pseudoaneurysm, and one thrombosed superficial femoral artery were detected for a major vascular complication rate of 9%. Pseudoaneurysm formation was associated with the use of heparin after removal of the arterial sheath. Seven pseudoaneurysms (initial extravascular cavity size range 1.3 to 3.5 cm) were followed with weekly duplex scans, and all thrombosed spontaneously within 4 weeks of detection. The three patients with isolated arteriovenous fistulas were each followed for at least 8 weeks, and the arteriovenous fistulas persisted. Early surgical intervention for postcatheterization femoral pseudoaneurysms is usually unnecessary as thrombosis often occurs spontaneously. We would advocate an operative approach for pseudoaneurysms that are symptomatic, expanding, or associated with large hematomas. Iatrogenic femoral arteriovenous fistulas should be considered for elective repair, but this may be delayed for several weeks without adverse sequelae.

                Author and article information

                Nephron Extra
                S. Karger AG
                September – December 2014
                03 October 2014
                : 4
                : 3
                : 155-158
                aDepartment of Medicine, and bDivision of Nephrology, Department of Medicine, University of Calgary, Calgary, Alta., Canada
                Author notes
                *Dr. Stefan Mustata, 7007 14 St SW, Calgary, AB T2V 1P9 (Canada), E-Mail
                366451 PMC4224231 Nephron Extra 2014;4:155-158
                © 2014 S. Karger AG, Basel

                Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (, applicable to the online version of the article only. Distribution permitted for non-commercial purposes only. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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                Figures: 1, Pages: 4
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