Femoral arteriovenous fistula associated with calf pain 2 months after removal of a haemodialysis catheter

Analysis and Classification of Postcatheterization Femoral Arteriovenous Fistulas Based on Color Doppler Examinations

OBJECTIVE

To analyze and classify arterial supply and venous drainage of postcatheterization femoral arteriovenous fistulas (AVFs).

METHODS

A review of extremity Doppler reports identified 77 femoral AVFs in 75 patients. Doppler exams were reviewed retrospectively. Fistulas were classified as above or below the common femoral artery bifurcation and subclassified based on the location of arterial inflow and venous outflow.

RESULTS

Arterial inflow originated above the femoral bifurcation in 32 cases. The communication was between the common femoral artery and the superficial circumflex iliac vein in 25 of 32 cases and between a branch of the common femoral or external iliac artery and the common femoral or external iliac vein in 4 of 32 cases. In 3 of 32 cases, AVFs arose from the common femoral artery, but the venous outflow was not determined. Arterial inflow originated from the superficial femoral artery in 23 cases. Venous outflow originated from the common femoral vein in 10 of 23 cases, the femoral vein in 7 of 23 cases, and the lateral circumflex femoral vein in 6 of 23 cases. Arterial inflow originated from the deep femoral artery in 12 cases. Venous outflow originated from the common femoral vein in 6 of 12 cases and from the lateral circumflex femoral vein 6 of 12 cases. In 8 cases, the AVF originated below the bifurcation, but the arterial inflow was not classified. In 2 cases, it was impossible to determine if the AVF originated above or below the bifurcation.

CONCLUSIONS

Iatrogenic femoral AVFs arise above the femoral bifurcation more often than previously recognized. Classification based on the arterial inflow and venous outflow provides a straightforward means of describing these fistulas.

Severe leg swelling following removal of a temporary femoral venous hemodialysis catheter

Temporary central venous catheters are commonly used for patients who require emergency hemodialysis (HD). An arteriovenous fistula (AVF) is a rare complication of this procedure. In this case report, we present a patient who was diagnosed with an iatrogenic femoral AVF after cannulation of the right femoral vein with a temporary HD catheter.

An Unusual Variational Anatomy of the Medial Circumflex Femoral Artery: A Case Report of a Post-catheterization Femoral Arteriovenous Fistula

The medial circumflex femoral artery (MCFA) typically presents as a major branch of the profunda femoris artery or it can also directly originate from the common femoral artery. Many anatomical variations of the MCFA have been described due to their clinical significance. We herein report a case of an unusual anatomical variation of the MCFA crossing anterior to the femoral vein that led to iatrogenic arteriovenous fistula formation after cardiac catheterization. The identification of such rare vascular anatomical variations is of great importance when attempting femoral arterial or venous puncture in order to minimize unnecessary complications.