Stammler Frank
Praxis für Gefäßmedizin und Venenzentrum, Bad Wildbad, GERMANY.
Dtsch Med Wochenschr. 2024 Feb;149(4):175-178. doi: 10.1055/a-2220-0678. Epub 2024 Jan 29.
Spontaneous arteriovenous fistulas (AVF), in contrast to iatrogenic or post-traumatic ones, are extremely rare and only sporadically published in the literature. In the absence of exposure risk, the diagnosis of AVF can be challenging, especially if it is an incidental finding.
An 80-year-old female patient presented to our vascular consultation because of swelling of the left leg due to varicosis. For years, she had also noticed that the right foot seemed to be cooler. Percutaneous catheter examinations via the groin had not been performed, and she could not remember any groin injuries.
Truncal varicosis of the great saphenous vein confirmed clinically and sonographically. In addition, with peripheral pulses obtained, the right foot appeared slightly cooler but not discolored. On auscultation, a systolic-diastolic murmur accompanied by palpable buzzing was heard in the right groin. Color duplex sonography showed a coarse color mosaic pattern between the common femoral artery (AFC) and the anterior saphenous vein (VSAA) in the sense of aliasing ("confetti phenomenon"). A fistula channel between the AFC and VSAA could be visualized, in which very high systolic-diastolic flow velocities prevailed; pulsatile and turbulent flow was present in the region of the crosse-near femoral vein.
Endovenous laser ablation was performed for symptomatic truncal varicosis of the left leg. Under ultrasound-guided compression of the afferent artery and fistula at the right groin, the fistula flow did not stop. The patient was reluctant to undergo a proposed interventional closure of the AVF. In follow-up over 4 years, no signs of cardiac insufficiency or critical limb ischemia developed.
Spontaneous femoral AVF is a rarity. Characteristic clinical findings lead to a targeted use of color duplex sonography with correct interpretation of artifacts that can otherwise be easily missed.
与医源性或创伤后动静脉瘘不同，自发性动静脉瘘极为罕见，在文献中仅有零星报道。在没有暴露风险的情况下，动静脉瘘的诊断可能具有挑战性，尤其是当它是偶然发现时。
一名80岁女性患者因静脉曲张导致左腿肿胀前来我们的血管科就诊。多年来，她还注意到右脚似乎更凉。未进行过经腹股沟的经皮导管检查，她也记不起腹股沟有任何损伤。
临床和超声检查证实大隐静脉存在躯干静脉曲张。此外，在触及外周脉搏时，右脚显得稍凉但无变色。听诊时，在右腹股沟听到收缩期 - 舒张期杂音并伴有可触及的震颤。彩色双功超声显示在股总动脉（AFC）和大隐静脉前支（VSAA）之间出现了类似混叠的粗糙彩色镶嵌图案（“五彩纸屑现象”）。可以看到AFC和VSAA之间的瘘管通道，其中存在非常高的收缩期 - 舒张期血流速度；在股静脉交叉附近区域存在搏动性和湍流。
对左腿有症状的躯干静脉曲张进行了静脉内激光消融术。在超声引导下对右腹股沟的输入动脉和瘘管进行压迫时，瘘管血流并未停止。患者不愿接受提议的动静脉瘘介入封堵术。在4年的随访中，未出现心脏功能不全或严重肢体缺血的迹象。
自发性股动静脉瘘很罕见。特征性的临床表现有助于有针对性地使用彩色双功超声，并正确解读否则可能容易遗漏的伪像。
