Incidence and clinical outcome of iatrogenic femoral Arteriovenous fistulas: Implications for risk stratification and treatment

We sought to determine the incidence of arteriovenous fistulas (AVF), identify risk factors for AVF, and follow up the clinical outcome of femoral AVF. Arteriovenous fistulas are a potential harmful complication of cardiac catheterization. Incidence and clinical outcome of iatrogenic AVF are unknown...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2002-07, Vol.40 (2), p.291-297
Main Authors: KELM, Malte, PERINGS, Stefan M, JAX, Thomas, LAUER, Thomas, SCHOEBEL, Frank C, HEINTZEN, Matthias P, PERINGS, Christian, STRAUER, Bodo E
Format: Article
Language:English
Subjects:
Aged
Arteriovenous Fistula - diagnosis
Arteriovenous Fistula - epidemiology
Arteriovenous Fistula - etiology
Arteriovenous Fistula - therapy
Biological and medical sciences
Blood and lymphatic vessels
Body mass index
Cardiac Catheterization - adverse effects
Cardiology
Cardiology. Vascular system
Case-Control Studies
Clinical outcomes
Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous
Drug therapy
Female
Femoral Artery - abnormalities
Femoral Vein - abnormalities
Flow velocity
Follow-Up Studies
Gender
Germany - epidemiology
Humans
Hypertension
Incidence
Intubation
Male
Medical sciences
Middle Aged
Multivariate analysis
Odds Ratio
Prospective Studies
Research Design
Risk Factors
Thrombosis
Time Factors
Treatment Outcome
Veins & arteries
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Summary:We sought to determine the incidence of arteriovenous fistulas (AVF), identify risk factors for AVF, and follow up the clinical outcome of femoral AVF. Arteriovenous fistulas are a potential harmful complication of cardiac catheterization. Incidence and clinical outcome of iatrogenic AVF are unknown so far, although important for risk stratification and treatment. A total of 10,271 consecutive patients undergoing cardiac catheterization were followed up prospectively over a period of three years. Diagnosis of AVF was performed by duplex sonography. The incidence of AVF was 0.86% (n = 88). The following significant and independent risk factors for AVF were identified: high heparin dosage (odds ratio [OR]) = 2.88), coumadin therapy (OR = 2.34), puncture of the left groin (OR = 2.21), arterial hypertension (OR = 1.86), and female gender (OR = 1.84). Within 12 months 38% of all AVF closed spontaneously. No signs of cardiac volume overload or limb damage were observed in patients with persisting AVF. None of the risk factors for AVF influenced the incidence or the rate of AVF closure. Only intensified anticoagulation showed a tendency to extend AVF persistence. Almost 1% of patients undergoing cardiac catheterization acquire femoral AVF, for which patient- and procedure-related risk factors could be identified. One-third of iatrogenic AVF close spontaneously within one year. Cardiac volume overload and limb damage are highly unlikely with AVF persistence. Thus, a conservative management for at least one year seems to be justified.
ISSN:0735-1097
1558-3597
DOI:10.1016/S0735-1097(02)01966-6