Evaluation of traumatic groin arteriovenous fistulas with duplex Doppler sonography.

Abstract

Femoral arteriovenous fistula is a rare complication of percutaneous transfemoral catheterization. We report the duplex Doppler findings of three such cases. Continuous positive diastolic arterial flow, as well as an abnormal venous flow pattern, was observed in all cases. When present, these Doppler spectral changes support the diagnosis of arteriovenous fistula.

Diagnostic criteria for locating acquired arteriovenous fistulas with color doppler sonography

“…Our results were similar to those of a previous study, in which in 1 of 3 patients with a trauma-induced AVF of the groin, the diameters of the femoral artery proximal and distal to the fistula site were approximately equal, as were those of the femoral vein. 8 In our study, the diameter of the proximal artery was at least 1.2 mm larger than that of the distal artery in 70% of AVFs. On the other hand, a focal point of maximal venous dilatation may appear in other vascular diseases, such as valvular incompetence.…”

“…At least 1 other report has described difficulty pinpointing the actual communication of an AVF without the use of color Doppler imaging. 8 Other color Doppler imaging findings (a communicating jet, turbulences around a fistula site, and a focal perivascular color artifact) are also insufficient for locating a fistula site because only nonspecific morphologic changes in vessels and color Doppler signals are visualized. 8,9 Certainly, a communicating jet between the corresponding artery and vein on color Doppler sonography indicates the location of a fistula; in our study, this finding led to the identification of 5 more fistula sites on color Doppler imaging than on gray-scale sonography.…”

“…7,8,11 In the extremities, arterial waveforms have a typical triphasic high-resistance pattern, with an anterograde systolic peak, a brief early diastolic retrograde peak, and a final anterograde diastolic peak. In all 10 cases of extremity AVF in our study, spectral Doppler analysis of the arteries proximal to the fistula site demonstrated a lowresistance pattern, with persistent forward flow throughout the cardiac cycle, whereas spectral Doppler analysis of the arteries distal to the fistula site demonstrated a high-resistance pattern, with reversal of or no diastolic flow.…”

“…Color Doppler imaging has previously been used to diagnose femoral AVFs, [7][8][9][10][11] iliac AVFs, and renal AVFs. 5,13,14 The purpose of this study was to evaluate acquired AVFs and to determine criteria for locating them using color Doppler sonography.…”

Acquired intercostal arteriovenous fistula: color Doppler ultrasonographic diagnosis

“…lC, 0). 5 The color Doppler ultrasonographic characteristics include perivascular color artifact (reflecting tissue vibration from turbulent intravascular flow)6 and a visible connection between artery and vein.7· 8 All of these abnormalities were present in this patient.…”