Vascular

Arteriovenous malformation

• Developmental defect

  • Can be anywhere

    • Intracranial > neck > extremities > trunk/ABD

SSX

• ASX or pink/blue/warm skin ➔ blushing skin/tortuous veins/palpable thrill ➔ pain, skin ∆'s (ulcers/ischemia) ➔ high output cardiac failure

DX

• Initial: US

• MR/CT angiography (catheter based to plan tx)

TX

• Pain control and compression garments until definitive vascular surgery

Traumatic AV fistula

• Penetrating trauma (or blunt fractures that ➔ fractures) and iatrogenic (invasive procedure)

PATHO

• Direct communication between artery and vein ➔ shunting of blood

  • Diverting blood from arteries to veins (high to low pressure) ➔ ↑ venous volume & pressure ➔ ↓ peripheral resistance

• If large/chronic: ↓ arterial pressure ➔ ↑ CO & ↑ circulating volume ➔ dilation and high-output HF

SSX

• May be asx but have hx of trauma

• Local thrills, bruits, pulsatile mass. Shunting can ➔ distal ischemia

• Nicoladoni-Israel-Branham's sign: Compress fistula or artery proximal to ➔ ↓ HR

  • Compressing fistula ➔ ↑ peripheral resistance ➔ ↑ afterload ➔ reflex bradycardia

• Large/chronic ➔ CHF (high output), cardiomegaly, pain, limb overgrowth

DX

• Gold standard: Arteriography

• Duplex doppler, CT-angiography

TX

• Surgical repair