Doppler Flowmeter Aids in Successful Pediatric Arteriovenous Fistula Repair

Detecting residual arteriovenous fistula (AVF) in small children is challenging. We report a case of a pediatric patient who required a reoperation for an iatrogenic femoral AVF due to an undetected residual AVF during the initial operation. Using a bidirectional Doppler volume flowmeter was helpful in ensuring complete resection. A 4-year-old girl with univentricular congenital heart disease and multiple surgeries for univentricular repair was referred for an iatrogenic right femoral AVF after several diagnostic and therapeutic catheterizations. Angiography before Fontan operation revealed the AVF, necessitating surgical intervention concomitantly. Initially, the AVF was ligated, and no residual AVF was detected by palpation. However, 1 year later, angiography and duplex ultrasound showed a residual AVF, causing a hemodynamic burden. Concerns about potential leg length discrepancy and elevated inferior vena cava pressure led to a reoperation. The AVF was divided: ligated, transected, and oversewn. Postoperative Doppler confirmed the absence of turbulent flow and normalized blood flow patterns. She had an uneventful recovery and was discharged the next day. Two weeks later, duplex ultrasound confirmed no residual AVF, with normalized blood flow in the right external iliac artery.