Abstract
Introduction
Iatrogenic arteriovenous fistulas (AVF) are usually formed between the common femoral artery (CFA) and the common femoral vein (CFV). Diagnosis is confirmed with duplex sonography (DS). They are usually treated conservatively or with surgery. AVF arising from the inferior epigastric (IEA) branch of the CFA are rare and present unique challenges, as DS usually cannot differentiate AVF origin from CFA or IEA.
Case Study
A 21-year-old woman presented with mild groin discomfort and bruit after an electrophysiological procedure via the right CFV. DS confirmed an AVF, but computed tomography angiography was performed to assess the origin. A small fistula was seen from the proximal right IEA to CFV. This offered an opportunity to percutaneously close the fistula by coiling the IEA if clinically indicated. However, a repeat DS 6 weeks later demonstrated spontaneous AVF closure.
Conclusion
DS is usually the only diagnostic study performed for evaluation of AVF. Diagnosis is usually made on the basis of relatively low resistance flow in the CFA, increased pulsatile CFV flow, and high-velocity, disturbed pulsatile flow in the tract. Occasionally, turbulent flow results in soft-tissue vibrations (perivascular speckling) that obscure visualization of AVF tract. Computed tomography angiography defined the exact origin of the fistula from proximal IEA and offers a complimentary role in assessment of AVF and their management.
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