Arteriovenous fistula simulating arteriovenous malformation

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Diagnostic Imaging

Background:

• Distinguishing between arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs) is critical for effective treatment.
• AVMs are congenital, complex lesions, while AVFs are typically acquired, with a single arterial-venous communication.

Observation:

• A 36-year-old male with a 20-year misdiagnosis of AVM was treated with arterial ligations, offering only temporary relief.
• Impaired angioaccess due to previous interventions delayed the correct diagnosis of an arteriovenous fistula, likely post-tonsillectomy.
• Successful occlusion of the arteriovenous fistula using detachable balloons led to the resolution of the mass and headaches.

Findings:

• Arteriography is key in differentiating AVFs (single communication) from AVMs (multiple communications).
• Proximal arterial ligation for presumed AVMs can be ineffective and detrimental, promoting collateralization and hindering future diagnostic access.
• Arteriovenous fistulas are curable by obliterating the single communication, unlike aggressive AVMs requiring complete excision.

Implications:

• Accurate differential diagnosis between AVFs and AVMs is paramount for appropriate patient management.
• This case underscores the limitations of arterial ligation and the importance of precise diagnosis for vascular anomalies.
• Endovascular occlusion offers a definitive treatment for arteriovenous fistulas, contrasting with the surgical challenges of arteriovenous malformations.