The focus of this presentation was to emphasize the role of different diagnostic and therapeutic modalities and the difficult clinical presentation of arteriovenous fistulas. Studies of the natural history of pseudoaneurysms and arteriovenous fistulae that result from accidental or violent trauma reveal a low incidence of spontaneous resolution and high likelihood of complications, including bleeding, arterial thrombosis, skin erosions, adjacent nerve compression, venous hypertension, or congestive heart failure. Because of the rapid disease progress, operative treatment of such cases should be performed as soon as possible. This is supported by good follow-up results in operatively treated patients. 6,7 The goals of surgery are the early eradication of the fistula, prevention of complications and the establishment of arterial and venous continuity.
Arrows show the direction of blood flow.
Operations that merely decrease fistula flow should be avoided if possible. The natural history of postcatheterization pseudo-aneurysms and fistulae, on the other hand, seems to be different. 8 a number of studies have suggested that a proportion of these injuries do resolve spontaneously without the need for any form of intervention. Recently, an experimental study was done on a rat groin flap model to assess the possible effects of arteriovenous fistulas on the viability of skin flaps. It was concluded that island skin flap circulation is negatively affected by an AVF proximal to the flap pedicle.