Wayne Francis Yakes MD, Presenter: Nothing to Disclose

To determine the etiology of acquired non-traumatic arteriovenous vascular fistula (AVF), evaluate their venous physiology and determine management strategies. Non-traumatic acquired AVF of the peripheral vascular system and its management has not been described or published in the world’s literature.

Ten patients (2 males, 8 female; age range 47 – 84 yrs; mean age: 66 years) presented with acquired peripheral arteriovenous fistualization of veins causing swelling and venous hypertensive changes in the lower extremities and left upper extremity. All presented with enlargement and swelling of their left lower extremity. Additionally, one patient had enlargement of her left buttock; one patient had bilateral lower extremity severe swelling with venous stasis changes in the legs, one patient had gross edema of the left upper extremity, two patients had non-healing venous stasis ulcers complicated with cellulitis; and one patient had a left femoral fracture that was surgically treated previously and due to a spine injury, was paraplegic. All patients had great difficulty with ambulating. No patient had a history of blunt or penetrating trauma. All patients underwent ultrasound, arteriography and lower extremity venography in their work-up.    

All patients were discovered to have acquired (non-congenital) extensive AVF in the pelvic, groin, leg, thigh and left shoulder; four patients had major venous chronic occlusions. After treating their AVF endovascularly, all patients had resolution of their swelling despite the venous occlusions. The non-healing ulcers totally healed.    

This lesion is not described in the world’s literature. The only similar lesion reported in the world‛s literature is dural AVF of the saggital/ transvers/sigmoid/cavernous sinuses. This is the first report of this entity occurring in the periphery and successful management strategies.     

Cure of these difficult lesions is possible with endovascular approaches utilizing coils and by eliminating the fistulas and the venous hypertension; stenting of the disease vein segments also proved successful in eliminating the numerous AVF in the vein wall.   

Yakes, W, Acquired Non–Traumatic Peripheral Arteriovenous Fistula  .  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015024.html