Femoral Arteriovenous Fistula following Cardiac Catheterization: An Anatomic Explanation

Author:

Sidawy A. N.,Neville R. F.,Adib H.1,Curry K. M.

Affiliation:

1. Department of Radiology, Veterans Affairs Medical Center, George Washington University and Georgetown University, Washington. DC, USA

Abstract

The exact etiology of femoral iatrogenic arteriovenous fistula (AVF) following cardiac catheterization is not known. The most common explanation is simultaneous placement of arterial and venous catheters for left and right heart catheterization. Using a strict protocol for groin examination before and after cardiac catheterization, seven patients were found to have a groin thrill and/or bruit as a result of AVF after catheterization in the period from July 1986 to December 1990; one patient had two fistulas, making a total of eight. During the same period, a total of 2609 cardiac catheterizations were performed using the Seldinger technique; the incidence of AVF after the procedure was thus 0.22%. Arteriography was used to confirm the presence of the fistulas and identify their exact location. All eight lesions originated below the bifurcation of the common femoral artery (CFA). Three originated at the superficial femoral artery (SFA) and five at the profunda femoris artery (PFA). In the patient with two fistulas, one originated at the SFA and one at the PFA. The veins involved were the superficial femoral (SFV) in two AVFs and the profunda femoris (PFV) or its lateral circumflex branch in six. The fact that all eight fistulas originated below the bifurcation of the CFA points to a possible anatomic explanation for the formation of iatrogenic AVF. The CFA and common femoral vein (CFV) are located side by side, which makes it difficult to puncture both with one stick Below the bifurcation, the PFV crosses laterally behind the proximal SFA and then lies in a posterior location to the PFA. In addition, the SFV moves laterally behind the SFA to rest posterior to it. A through-and-through puncture of the SFA or PFA can cause direct communication between these arteries and the SFV or PFV, leading to formation of an AVF. Puncturing the CFA or CFV above their bifurcations will lead to a marked decrease in the incidence of AVF following cardiac catheterization.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging,Surgery

Cited by 2 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Procedural Complications;Complication Management In The Cardiac Catheter Laboratory;2023

2. Case Report: Gigantic Arteriovenous Femoral Fistula Following Cardiac Artery Catheterization;Frontiers in Surgery;2022-02-07

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