Mega-fistula

Ram, Rapur; Sangeetha, B; Chaitanya, V; Reddy, MH; Kumar, Avnish; Sivakumar, V.

doi:10.4103/0971-4065.175979

Cited by 5 publications

(3 citation statements)

References 3 publications

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“…5 In some patients this response is exaggerated, with extreme venous dilation resulting in a megafistula with high-output congestive heart failure. 1,2 In rare cases, lengthening and redundancy are seen with outflow obstruction, most notably cephalic arch stenosis, as was the case in our patient.…”

Section: Discussionsupporting

confidence: 71%

“…One such entity is the development of a megafistula, which has previously been defined in the literature. 1,2 Aneurysms complicate up to 10%–30% of AVF, and several treatment strategies intended to preserve the conduit exist, including both open and endovascular options. 3,4 We present a case of a young patient with outflow stenosis at the cephalic arch who developed a severe aneurysmal degeneration and resultant high-output cardiac failure.…”

Section: Introductionmentioning

confidence: 99%

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Salvage of a megafistula causing high-output cardiac failure in a young adult with aneurysmorrhaphy and banding

Goldschmidt

Schafer

Hariri³

et al. 2021

J Vasc Access

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We present the case of a 21-year-old male with significant lengthening and aneurysmal degeneration of his brachiocephalic arteriovenous fistula resulting in a megafistula and high-output cardiac failure. A computed tomography angiogram showed narrowing at the cephalic arch. Further evaluation during the operation revealed kinking and elongation of the fistula in addition to compression of the cephalic arch in the deltopectoral groove leading to outflow obstruction. The aneurysmal fistula was treated successfully with aneurysmorrhaphy of the remaining conduit and banding of the inflow. This case demonstrates a unique etiology of venous outflow obstruction for a fistula and describes the surgical approach to its treatment in a young patient suffering from cardiac failure.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Salvage of a megafistula causing high-output cardiac failure in a young adult with aneurysmorrhaphy and banding

Goldschmidt

Schafer

Hariri³

et al. 2021

J Vasc Access

View full text Add to dashboard Cite

show abstract

“…5 Pathogenesis for this condition in dialysis patients is a complex interplay between factors like vessel wall remodeling secondary to repeated AVF needling, increased access pressure secondary to outflow vein stenosis, and wall tension (biologic and physical factors interplay) which results in development of this aneurysmal dilatation of vessels. 6…”

Section: Discussionmentioning

confidence: 99%

The Hulk Hand!—In a Hemodialysis Patient

Prabhakaran

Mahapatra

Singh

et al. 2021

Indian Journal of Clinical Medicine

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A 35-year-old gentleman who was on maintenance hemodialysis for last 20 months presented with progressive swelling of the left upper limb. Initially, he had right nontunneled internal jugular vein (IJV) catheter followed by left nontunneled IJV catheter through which he received dialysis for 2 months. Further, his left brachiocephalic fistula (BCF) was created 18 months back. Since then, he was on regular thrice weekly dialysis through BCF. He started developing swelling of the left upper limb 8 months after fistula creation, which was gradually increasing. Blood flow was found to be normal during dialysis, examination suggestive of entire left upper limb swelling with thick induration. Doppler showed dilated outflow veins with high flow without any narrowing/stenosis of veins. Computed tomography venography done showed left brachiocephalic vein stenosis. He was found to have mega-fistula secondary to central vein stenosis which was managed successfully being discussed in this case report. Undiagnosed occult central venous stenosis in the prearteriovenous fistula (AVF) construction can manifest in various ways; one of them is as mega-fistula. It is the generalized aneurysmal dilatation of the entire outflow vessels of an AVF. Management option for this condition is limited depending on the etiology, fistula flow has to be reduced either by banding of the vessel or by fistula closure. Assessment of central veins before AVF construction and regular access surveillance in dialysis patients may prevent complications like these.

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