ARTERIOVENOUS FISTULA GENERAL SURGERY BY AKASH SURESH.pptx

ARTERIOVENOUS FISTULA GENERAL SURGERY BY AKASH SURESH

1. AKASH SURESH, THIRD YEAR BDS, MALABAR DENTAL COLLEGE AND RESEARCH CENTRE ARTERIOVENOUS FISTULA 20/02/2025

2. TABLE OF CONTENTS Contents ARTERIOVENUS FISTULA INTRODUCTION TYPES SITES CLINICAL FEATURES COMPLICATIONS INVESTIGATIONS TREATMENT

3. ARTERIOVENUS FISTULA An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein, bypassing the capillary network. This condition can be congenital or acquired, with some cases occurring due to trauma, surgery, or as a result of medical procedures such as dialysis access creation. Introduction ARTERIOVENUS FISTULA

4. TYPES ARTERIOVENUS FISTULA 1.CONGENITAL AVF 2.ACQUIRED AVF

5. Congenital arteriovenous fistula (AVF) is a rare vascular anomaly present at birth, resulting from abnormal blood vessel development. 1.CONGENITAL AVF ARTERIOVENUS FISTULA

6. SITES ARTERIOVENUS FISTULA Toe Or Finger Of Lims Lungs Brain In Circle Of Wills Organs Like Bowel,liver

7. Structural changes in the limb : • Limb is lengthened due to increase blood flow since developmental period (Fig. 4.22). • Limb girth also increased. • Limb is warm . • Continuous thrill and continuous machinery murmur all over the lesion. • Dilated arterialized varicose veins are seen due to increased blood flow and due to valvular incompetence. • Often there will be bone erosion or extension of AVF into the bone as such. CLINICAL FEATURES ARTERIOVENUS FISTULA

8. Physiological changes : Because of the hyperdynamic circulation, there will be increased cardiac output and so often congestive cardiac failure . CLINICAL FEATURES ARTERIOVENUS FISTULA

9. Hemorrhage Thrombosis Cardiac Failure COMPLICATIONS ARTERIOVENUS FISTULA

10. INVESTIGATIONS ARTERIOVENUS FISTULA Angiogram (Fig. 4.23) Doppler study X-ray of the part

11. Avoid injury. Ligation of feeding artery. Sclerosant therapy. Therapeutic embolization. Amputation when required (only) as life saving procedure. TREATMENT ARTERIOVENUS FISTULA

12. Acquired arteriovenous fistula (AVF) occurs due to trauma, surgery, or medical conditions, leading to an abnormal connection between an artery and a vein. 2.ACQUIRED AVF ARTERIOVENUS FISTULA

13. Trauma in— a. Femoral region. b. Popliteal region. c. Brachial region. d. Wrist. e. Aorta venacaval . f. Abdomen—It may be following road traffic accidents, penetrating wounds, cock-fight injury ! (common in South India). CAUSES ARTERIOVENUS FISTULA

14. 2. After vascular surgical intervention for major vessels. 3. Therapeutic: For renal dialysis, AVF is created ( cimino fistula ) to achieve arterialization of veins and also to have hyperdynamic circulation. So as to have easy adequate venous assess for long time hemodialysis . Common sites are wrist, brachial, and femoral region. CAUSES ARTERIOVENUS FISTULA

15. Physiological changes : Cardiac failure due to hyperdynamic circulation . Structural changes : Changes at the level of fistula : Blood flows from high pressure artery to low pressure vein causing diversion of most of the blood. Between the artery and vein, at the site of fistula, dilatation develops with fibrous sac formation called as aneurysmal sac. This presents as warm, pulsatile, smooth, soft,compressible swelling at the site with continuous thrill and continuous machinery murmur. It is warm at the site. PATHOPHSIOLOGY ARTERIOVENUS FISTULA

16. Structural changes : Changes below the level of the fistula: Because of diversion of arterial blood distal part becomes ischemic. Because of high pressure veins become arterialized, with valvular incompetence causing varicose veins. PATHOPHSIOLOGY ARTERIOVENUS FISTULA

17. Structural changes : Changes proximal to the fistula: Hyperdynamic circulation causing cardiac failure. If pressure is applied to the artery proximal to the fistula, swelling will reduce in size, thrill and bruit will disappear, pulse rate and pulse pressure becomes normal. This is called as Nicoladoni’s sign or Branhan’s sign. Cardiac failure may be very severe in traumatic AVF (Often resistant to drug therapy). PATHOPHSIOLOGY ARTERIOVENUS FISTULA

18. • Doppler • Angiogram • Electrocardiogram • Echocardiography INVESTIGATIONS ARTERIOVENUS FISTULA

19. Excision of fistula and reconstruction of artery and vein with graft (Fig. 4.25). TREATMENT ARTERIOVENUS FISTULA

20. In emergency situation, quadruple ligation,i.e . both artery and vein above and below should be ligated without touching the fistula and sac. Patient recovers well from cardiac failure (Fig. 4.26). TREATMENT ARTERIOVENUS FISTULA

21. REFERENCE ARTERIOVENUS FISTULA Sriram Bhat M -SRB’s Surgery for Dental Students Rajgopal Shenoy – Manipal Manual of General Surgery with clinical methods for dental students – 3rd Edition

22. THANK YOU! THANK YOU! ARTERIOVENUS FISTULA