Arteriovenous fistula

Last updated: December 10, 2021

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An arteriovenous fistula is an abnormal connection between an artery and a vein. The most important examples include carotid-cavernous fistula and pulmonary arteriovenous fistula. A carotid-cavernous fistula is an abnormal communication between a carotid artery and the cavernous sinus. It is most commonly caused by trauma. This fistula leads to a high-pressure inflow of arterial blood into the venous sinuses, resulting in compression and damage to adjacent structures. The main symptom is diplopia, which is caused by compression injury of the oculomotor nerves. Other common symptoms include pulsatile tinnitus, exophthalmos, and headache. Diagnosis is established based on typical CT/MRI or angiography findings (e.g., enlarged cavernous sinus). The preferred treatment method is endovascular occlusion of the fistula with balloons or coils. A pulmonary arteriovenous fistula is an abnormal communication between the pulmonary artery and veins, and it leads to a high-pressure inflow of arterial blood into the venous system, causing venous congestion. The main symptom is dyspnea; other common symptoms include hemoptysis, platypnea and orthopnea, chest pain, and cyanosis. Diagnosis is established based on typical transthoracic contrast echocardiography, CT, and angiography findings (e.g., mass with feeding vessels). Treatment is only required for symptomatic patients, and the preferred treatment method is embolotherapy.

  • Definition: an abnormal communication between the carotid artery and the cavernous sinus
  • Classification
Types of carotid-cavernous fistula
Characteristics Direct carotid-cavernous fistula Indirect carotid-cavernous fistula
Description
Epidemiology
  • Most common type
  • Less common type
Etiology [1]
Onset of symptoms
  • Typically rapid
  • Typically gradual

If not treated swiftly, carotid-cavernous fistulas may result in cerebral hemorrhage or infarction, intracranial hypertension, vision loss, or even death.

  1. Seeger JF, Gabrielsen TO, Giannotta SL, Lotz PR. Carotid-Cavernous Sinus Fistulas and Venous Thrombosis. AJNR Am J Neuroradiol. 1980; 1 : p.141-148.
  2. Halbach VV, Hieshima GB, Higashida RT, Reicher M. Carotid cavernous fistulae: indications for urgent treatment. AJR Am J Roentgenol. 1987; 149 (3): p.587-593. doi: 10.2214/ajr.149.3.587 . | Open in Read by QxMD
  3. Hanley M, Ahmed O, Chandra A, et al. ACR Appropriateness Criteria Clinically Suspected Pulmonary Arteriovenous Malformation.. J Am Coll Radiol. 2016; 13 (7): p.796-800. doi: 10.1016/j.jacr.2016.03.020 . | Open in Read by QxMD
  4. Mager JJ, Overtoom TT, Blauw H, Lammers JW, Westermann CJ. Embolotherapy of pulmonary arteriovenous malformations: long-term results in 112 patients.. J Vasc Interv Radiol. 2004; 15 (5): p.451-6. doi: 10.1097/01.rvi.0000126811.05229.b6 . | Open in Read by QxMD
  5. Shovlin CL, Jackson JE, Bamford KB, et al. Primary determinants of ischaemic stroke/brain abscess risks are independent of severity of pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia.. Thorax. 2008; 63 (3): p.259-66. doi: 10.1136/thx.2007.087452 . | Open in Read by QxMD

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