SONOWORLD : A-V fistula ultrasound

Username

Password

185,273 Registered Members as of 01/20/2021.

JavaScript must be enabled in order for you to use Sonoworld.com in standard view. However, it seems JavaScript is either disabled or not supported by your browser. To use standard view, enable JavaScript by changing your browser options, then try again.

Vascular » Peripheral Vascular

Iatrogenic arteriovenous fistula

« Back to Listing

Author(s) :

Daniel Merton

Presentation This patient had a recent cardiac catheterization with vascular access through the right femoral artery. One day after the catheterization a bruit was detected in the patient’s right groin. An ultrasound study was performed.

Caption: Color Doppler image of the right groin

Description: This CDI demonstrates a typical color bruit artifact associated with tissue vibration. The color bruit artifact obscures underlying anatomical information.

Caption: Spectral Doppler from above the vascular access site.

Description: This spectral Doppler waveform was obtained from the femoral artery above the vascular access site.

Caption: Spectral Doppler from below the vascular access site.

Description: A spectral Doppler waveform obtained from the femoral artery below the vascular access site.

Differential Diagnosis

Arteriovenous fistula
Arterial stenosis
Pseudoaneurysm
Arterial dissection

Final Diagnosis Arteriovenous fistula

Discussion

Arteriovenous fistulas (AVFs) can result when there is puncture of an artery and vein with a direct communication between the two injured vessels. A significant pressure gradient will result in a focal area of significantly increased velocity at the site of the AVF with flow directed from the artery to the vein. Color Doppler imagingof AVFs will often demonstrate a bruit artifact and/or a thrill may be palpable. Spectral Doppler analysis of the effected artery above the AVF will demonstrate a mono-phasic continuous waveform with elevated systolic and diastolic velocities. Flow in the injured artery distal to the AVF will generally have normal pulsatility. Spectral Doppler analysis of the effected vein central to the AVF will demonstrate “arterialized flow” with pulsations during systole and a lack of respiratory phasicity.

Color Doppler imaging will often demonstrate a color bruit artifact (as shown in Image 1) in the region of a previous arterial catheterization. A CDI image of the region using a higher CDI PRF (scale) may help to eliminate the CDI bruit artifact and permits identification of the precise site of the AVF communication (see Image 4). The use of the higher CDI PRF permits more accurate placement of a pulsed Doppler sample volume (see Image 5) to obtain a waveform typical of an AVF (i.e., a monophasic-continuous waveform with significantly elevated velocities throughout the cardiac cycle).

Case References

Liu JB, Merton DA, Mitchell DG, Needleman L, Kurtz AB, Goldberg BB: Color Doppler imaging of the iliofemoral region. Radiographics. 1990 10:403-412.
Mitchell DG, Merton DA, Liu JB, Goldberg BB: Superficial masses with color flow Doppler imaging. J Clinical Ultrasound. 1991 19:555-560
Helvie MA, Rubin J. Evaluation of traumatic groin arteriovenous fistulas with duplex Doppler sonography. J Ultrasound Med 1989;8:21.
Roubidoux MA, Hertzberg BS, Carroll BA, et al. Color flow and image-directed Doppler ultrasound evaluation of iatrogenic arteriovenous fistulas in the groin. J Clin Ultrasound 1990;18:463.
Fellmeth BD, Roberts AC, Bookstein JJ, Freischlag JA, Forsythe JR, Buckner NK, Hye RJ. Postangiographic femoral artery injuries: nonsurgical repair with US-guided compression. Radiology. 1991;178: 671–675
Coughlin BF, Paushter DM. Peripheral pseudoaneurysms: evaluation with duplex US. Radiology 1988;168:339.
Helvie MA, Rubin JM, Silver TM, et al. The distinction between femoral artery pseudoaneurysms and other causes of groin masses: value of duplex Doppler sonography. AJR Am J Roentgenol 1988;150:1177.
Fellmeth BD, Baron SB, Brown PR, et al. Repair of postcatheterization femoral pseudoaneurysms by color flow ultrasound guided compression. Am Heart J 1992;123:547.
Polak JF, Donaldson MC, Whittemore AD, et al. Pulsatile masses surrounding vascular prostheses: real-time US color flow imaging. Radiology 1989;170:363.
McCann RL, Schwartz LB, Pieper KS. Vascular complications of cardiac catheterization. J Vasc Surg 14:375, 1991.
Kresowik TF, Khoury MD, Miller BV, et al. A prospective study of the incidence and natural history of femoral vascular complications after percutaneous transluminal coronary angioplasty. J Vasc Surg 1991;13:328

Technical Details

Philips Medical Systems IU-22 scanner with L8-4 flat linear array probe

Other contents by this AuthorOther Cases in This Category

Vascular >> Peripheral Vascular

Popliteal artery aneurysm
An 85 year old male presented to the hospital with an acute intracranial bleed, thought to be secondary to amyloidosis. While in the hospital, he complained of swelling of the right leg. An ...

Right common femoral artery pseudoaneurysm
Patient presenting with a mass in the groin two weeks post femoral artery catheterization. A bruit was heard over the puncture site. Serial ultrasound scans were performed.

Pseudoaneurysmal dilatation of a right femoral AV fistula
A 50 year old man had a cardiac catheterization via the right femoral artery five months prior and he now presents with an ipsilateral groin mass. A bruit could be heard over the mass.

Cystic adventitial disease of the popliteal artery
A 32 year old man presents with history of right sided claudication. He has numbness, tingling and decreased distal pulsations of the right lower extremity . He has no history of smoking.

Peroneal artery pseudoaneurysm with calf hematoma
A 49 year old man status post motor vehicle accident and resultant left tibial and fibular fractures presents with left calf swelling for a week. He had been treated surgically for the fractures. ...

Baker's cyst
A 39 year old woman presents with acute pain and redness of left lower limb. She was referred for a venous Doppler study with clinical diagnosis of deep vein thrombosis.

Tumor thrombus in the femoral vein
A 45 year old woman presents with redness and edema of her right calf. An ultrasound was performed. She has no other complaints other than some pain around the right hip joint.

Retained catheter fragment
A 26-year-old woman with acute myeloid leukemia presents with a history of right femoral vein catheter insertion. She has had the catheter removed and presents for an ultrasound of the local ...

Femoral Arterio-venous fistula
A 50-year-old man status-post cardiac catheterization, now presents with a bruit in the right groin.

Femoral artery pseudoaneurysm
A 52-year-old woman status-post cardiac catheterization presents with a pulsatile mass in the groin.