Development of hemodynamically relevant acquired arterio-venous fistulae in patients with venous malformations

• Published in: Clinical hemorheology and microcirculation Vol. 83; no. 3; pp. 207 - 215
• Main Authors: Schramm, D., Wohlgemuth, W.A., Guntau, M., Wieprecht, M., Deistung, A., Bidakov, O., Wildgruber, M., Brill, R., Cucuruz, B.
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.01.2023
• Subjects: Arteriovenous Fistula - complications; Humans; Retrospective Studies; Thrombophlebitis - complications; Vascular Malformations - complications; slow flow malformation; fast flow malformation; Congenital vascular malformation; arterio-venous fistula
• ISSN: 1386-0291; 1875-8622
• DOI: 10.3233/CH-221610

BACKGROUND: Venous malformations tend to retain their slow-flow behavior, even in progressive disease or regression following therapy. OBJECTIVE: The aim of this study is to analyze the development of acquired hemodynamic relevant arterio-venous fistulae in patients with slow-flow malformations. METHODS: This study is a retrospective analysis based on a consecutive local registry at a tertiary care Interdisciplinary Center for Vascular Anomalies. Patients with venous malformations and development of secondary arterio-venous fistulae were included. Indications for therapy of the vascular malformation were based on patients’ symptoms and complications. The following endpoints were of clinical interest and were assessed: origin of development of arteriovenous fistula, development of secondary comorbidities as a result of the vascular malformation. For analysis we focused on descriptive statistics. RESULTS: Out of 1213 consecutive patients with vascular malformations, in 6 patients perfusion changed from slow flow to arterio-venous fast-flow patterns. Four patients developed the fistula after local trauma in the area of the malformation, the other 2 patients developed the fistula due to progression of the disease and recurrent thrombophlebitis. These 2 patients had no trauma or interventions at the time of arterio-venous fistula development. CONCLUSIONS: Acquired arterio-venous fast-flow fistula in patients with slow flow vascular malformation is very rare and might be a result of local trauma or the progression of the disease with recurrent thrombophlebitis. Specific evidence-based treatment options for these patients do not exist.