Rutherford's 173: Acquired Arteriovenous Fistulas скачать в хорошем качестве

Rutherford's 173: Acquired Arteriovenous Fistulas

#AcquiredAVF #ArteriovenousFistula #VascularSurgery #Endovascular #VascularTrauma #Iatrogenic #SpontaneousAVF #Embolization #StentGraft #RutherfordsVascular #MedicalDeepDive #VascularHealth This video deep dive, based on Rutherford's textbook chapters, focuses on acquired arteriovenous fistulas (AVFs). These are abnormal connections between an artery and a vein that form after birth, distinct from congenital malformations. First described by William Hunter in 1761, who noted vessel dilation and the characteristic thrill and bruit (vibration and whooshing sound), acquired AVFs became more common with changes in warfare and the advent of high-speed projectiles in the 19th century. Today, acquired AVFs are primarily caused by trauma, including penetrating injuries like gunshots and stab wounds, which are common in civilian settings. Blunt trauma can also cause them. Military injuries often result from blasts and explosives, differing in cause and location like the lower extremities. A significant source is iatrogenic causes, meaning injuries from medical procedures. These occur during procedures like cardiac catheterizations, central line placements, orthopedic surgery, and biopsies. The right femoral artery in the groin is a frequent site for iatrogenic AVFs. While technology like ultrasound guidance helps, careful technique remains crucial. Less commonly, AVFs can form spontaneously, typically when a weakened vessel wall (from conditions like atherosclerosis, infection, or connective tissue disorders like Marfan's or Ehlers-Danlos) erodes or ruptures into an adjacent vein. These can occur in major vessels like the aorta or iliac arteries. AVFs can happen almost anywhere in the body, each location presenting specific challenges. Diagnosis still involves feeling for the thrill and listening for the bruit, but is primarily reliant on modern imaging like colorflow duplex ultrasound, CT angiography, and MR angiography to visualise the fistula and blood flow. Management depends on the fistula's size, location, and symptoms. Small, asymptomatic ones might be watched. Symptomatic or larger ones require intervention. Endovascular options include embolization using coils or glue, or placing covered stent grafts to seal the connection. If these are not suitable or fail, open surgical repair is used. Outcomes have significantly improved with these varied approaches. The consequences of an AVF depend largely on its size and location, ranging from asymptomatic to causing serious issues like heart failure or ischemia.