Document Detail

Arteriovenous fistula simulating arteriovenous malformation.
MedLine Citation:
PMID:  3118316     Owner:  NLM     Status:  MEDLINE    
A 36-year-old man was thought (for 20 years) to have an arteriovenous malformation that could not be excised. Repeated ligations of proximal arterial supply to the vascular lesion were only transiently beneficial and may have caused a delay in correct diagnosis because of impaired angioaccess. Once it was discovered that he had an arteriovenous fistula--probably caused by a tonsillectomy at age 6--it was possible to occlude the fistula with detachable balloons. The mass and his headaches subsequently resolved. AV fistulas are caused by trauma. Growth of AVMs is often stimulated by trauma. Both lesions have pulsatile masses associated with overlying bruits. The differential diagnosis can usually be made by arteriography, since AV fistulas are acquired lesions with a single communication between an artery and a vein, whereas AVMs are congenital lesions with multiple, large arterial feeding vessels and numerous arteriovenous communications. Proper diagnosis is important, since AVMs are aggressive lesions that tend to regrow if not completely excised. AV fistulas will be cured if the single arteriovenous communication can be obliterated. Proper treatment for AV fistula is obliteration of the single arteriovenous communication, operatively or with occlusive balloons; treatment of AVMs--when possible--is excision of the entire mass, combined (on occasion) with preoperative embolization of the tumor mass. This case report emphasizes the importance of accuracy in the differential diagnosis between arteriovenous malformations and arteriovenous fistulas; moreover, it demonstrates both the ineffectiveness and deleterious consequences of proximal arterial ligation, since collateral development is enhanced and angiographic access is compromised.
H H Trout; A L Tievsky; K G Rieth; E M Druy; J M Giordano
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery     Volume:  97     ISSN:  0194-5998     ISO Abbreviation:  Otolaryngol Head Neck Surg     Publication Date:  1987 Sep 
Date Detail:
Created Date:  1987-12-01     Completed Date:  1987-12-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8508176     Medline TA:  Otolaryngol Head Neck Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  322-5     Citation Subset:  IM    
Department of Surgery, George Washington University Medical Center, Washington, D.C.
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MeSH Terms
Arteriovenous Fistula / diagnosis*,  therapy
Arteriovenous Malformations / diagnosis*,  therapy
Balloon Dilatation / methods*
Carotid Arteries / radiography
Diagnosis, Differential

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