Background: Iatrogenic arteriovenous fistulas are (IAVF) one of the main vascular complications of endovascular procedures. One of the important factors influencing. On the best treatment method selection is the morphological and functional assessment of the fistula by Doppler US. According to the own experience and literature rewiev, in the reports concerning the results of the Doppler US examination of the IAVF, very often many imprtant details from the vascular sorgeon point of view concerning the are not described. The purpose of this study was to carry out a structural and functional evaluation of iatrogenic arteriovenous fistulas.
Material and methods: 58 fistulas were examined in 57 patients who underwent endovascular procedures via a femoral approach. The vessels involved were evaluated by duplex Doppler sonography (DDS). To estimate the shunt volume (SV), three different measurement methods were used with an evaluation of their practical utility.
Results: In 49.1% of cases the AVF originated from the deep femoral artery (DFA), in 36.2% from the superficial femoral artery (SFA) and in 15.5% from the common femoral artery (CFA). The veins involved were the femoral veins or the superficial femoral veins in 40.5% and in 49.5% the lateral circumflex femoral vein (LCFV) or the tributaries of the great saphenous vein. The SV depended on the type of vein involved and was significantly lower in cases of injuries of the main veins.
Conclusions: All punctured segments of the femoral arteries may be involved in the development of arteriovenous fistulas with a prevalence of vessels localized below the bifurcation of the CFA. The fistulas between the CFA and tributaries of the saphenous vein are especially difficult to detect. At the same time, these fistulas are characterized by the smallest shunt volume, which can qualify them for conservative treatment. The best way to define the shunt volume through a fistula seems to be the measurement of artemial flow volumen above and below the fistula or the measurement of the venous flow of the proximal segments of both CFVs.