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Iatrogenic femoral arteriovenous fistula
R E Marsan1, V McDonald, S Ramamurthy
1Foster McGaw Hospital, Maywood, Illinois.
Insights
Cardiac angiography can lead to femoral arteriovenous fistulas due to incorrect puncture site selection. Using anatomical landmarks like the inguinal ligament or fluoroscopy can help prevent these iatrogenic injuries.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Radiology
Background:
- Iatrogenic femoral arteriovenous fistulas are a known complication of vascular access procedures.
- Superficial and deep femoral arteries are common origins for these fistulas.
- Cardiac angiographic procedures are frequently associated with this complication.
Purpose of the Study:
- To report a series of iatrogenic femoral arteriovenous fistulas.
- To identify the cause of these fistulas, specifically the use of the femoral crease as a landmark.
- To propose methods for minimizing this complication.
Main Methods:
- Retrospective review of twelve cases of iatrogenic femoral arteriovenous fistulas.
- Analysis of the procedures leading to fistula formation.
- Evaluation of landmark accuracy for vascular access.
Main Results:
- Eleven of twelve reported fistulas originated from the superficial or deep femoral arteries.
- The majority of fistulas occurred following cardiac angiographic procedures.
- Femoral crease use as a landmark led to excessively distal puncture sites, increasing complication risk.
Conclusions:
- The femoral crease is an unreliable landmark for vascular access puncture.
- Accurate landmark identification is crucial to prevent iatrogenic femoral arteriovenous fistulas.
- Physical examination of the inguinal ligament or fluoroscopic guidance can improve puncture site accuracy and reduce complications.
Abstract:
Twelve iatrogenic femoral arteriovenous fistulas are reported, 11 of which arose from the superficial or deep femoral arteries. All but two occurred in association with cardiac angiographic procedures. It appears that the femoral crease was used as a landmark to establish the cutaneous entry point for vascular puncture and resulted in an excessively distal puncture site. The femoral crease is an unreliable landmark in many patients. This complication may be minimized by using physical examination to identify the level of the inguinal ligament or fluoroscopy to localize the distal half of the femoral head.