Acquired arteriovenous fistulas in children
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Acquired arteriovenous fistulas in boys, often linked to factor VIII deficiency or coagulopathy, can develop from venous or arterial punctures. Surgical ligation is advised for progressive, pulsatile masses to prevent complications.
Area of Science:
- Vascular Surgery
- Pediatric Hematology
- Diagnostic Imaging
Background:
- Acquired arteriovenous fistulas (AVFs) are rare in pediatric patients.
- Trauma from vascular access procedures can lead to AVF formation, particularly in individuals with underlying coagulopathies.
- The clinical presentation of AVFs can be insidious, manifesting as a pulsatile mass.
Purpose of the Study:
- To present a series of pediatric cases with acquired arteriovenous fistulas.
- To highlight the etiology, clinical course, and diagnostic findings associated with these fistulas.
- To recommend a management strategy for progressive AVFs.
Main Methods:
- Retrospective case series of five boys with acquired AVFs.
- Review of patient history focusing on vascular access and bleeding disorders.
- Clinical examination findings and magnetic resonance imaging (MRI) for diagnosis and characterization.
- Surgical intervention for symptomatic or enlarging lesions.
Main Results:
- Five boys developed acquired AVFs following single or repeated venous/arterial punctures.
- Four patients had factor VIII deficiency, and one had hepatic-induced coagulopathy.
- All patients presented with a slowly progressive, pulsatile mass over months.
- Complications arose from repeated inadvertent punctures of the fistulas in patients with coagulopathies.
- MRI effectively visualized the fistulas and associated pathology.
Conclusions:
- Acquired AVFs in pediatric patients can result from iatrogenic trauma, especially in those with bleeding diatheses.
- Early recognition and appropriate diagnostic imaging, such as MRI, are crucial.
- Surgical ligation is the recommended treatment for progressive and symptomatic arteriovenous fistulas.
Abstract:
Five boys with acquired arteriovenous fistulas are presented; four had factor VIII deficiencies, and one had a hepatic-induced coagulopathy. The cause of the fistula was the trauma induced by single or repeated venous and/or arterial punctures. All five developed a slowly progressive pulsatile mass of over a period of months. Patients with coagulopathies all developed complications with repeated inadvertent puncture of these masses. Clinical examination and magnetic resonance imaging scans clearly highlight this problem. Surgical ligation is recommended for progressive enlargement.