Pediatric Iatrogenic Arteriovenous Fistulas

Abstract

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Intraoperative Diagnosis of Bilateral Upper Limb Arteriovenous Fistulae in a Child: A Case Report

“…These symptoms or signs may also vary due to the time elapsed between the inciting event and the clinical presentation. 3,4,9 In our patient, the iatrogenic etiology of the fistulae probably stems from the history of multiple attempts at venous cannulation in both the antecubital fossae. Use of Doppler ultrasonography for making the initial diagnosis of arteriovenous fistulae, confirmation with CT angiography, management with surgical closure, and endovascular procedures or stenting of these lesions are described elsewhere in the literature.…”

“…Fistulae in the upper and lower extremities in children secondary to multiple attempts to establish vascular access, or due to trauma, have been reported in the literature. [2][3][4][5][6][7][8][9] To the best of our knowledge, this is the first report of bilateral upper extremity arteriovenous fistulae incidentally diagnosed in a child during surgery. We detected these arteriovenous fistulae after induction of general anesthesia.…”

“…Use of Doppler ultrasonography for making the initial diagnosis of arteriovenous fistulae, confirmation with CT angiography, management with surgical closure, and endovascular procedures or stenting of these lesions are described elsewhere in the literature. 3,8,9,12 A comprehensive preoperative history and examination are essential in children to diagnose these lesions as they may have implications for perioperative management. In our case, we decided to just monitor the fistulae because the patient was asymptomatic.…”

“…These symptoms or signs may also vary due to the time elapsed between the inciting event and the clinical presentation. 3,4,9…”

“…9 Though their incidence in children is between 0.03% and 0.3% from various sources, the true incidence of this condition is unknown. 3,10 Growing evidence, mainly in the form of case reports and small case series, describe iatrogenic pediatric arteriovenous fistulae of the lower extremities. [2][3][4][5][6] Only a few reports describe upper extremity arteriovenous fistulae in children, formed after multiple attempts at venipuncture, for hemodialysis, and due to trauma after a projectile injury.…”