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Surgery.(General 2).Vascular > Arterial.10.AV fistula > Flashcards

Arterial.10.AV fistula Flashcards

1
Q

Definition of AV fistula

A

Communication between an artery and vein

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2
Q

PATHOLOGICAL TYPES of AV fistula

A
  1. Aneurysmal varix

2. Varicose aneurysm

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3
Q

Aneurysmal varix in PATHOLOGICAL TYPES of AV fistula

A

Direct communication between an artery & vein.

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4
Q

Varicose aneurysm in PATHOLOGICAL TYPES of AV fistula

A

The artery & vein communicate through a false sac.

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5
Q

Etiology of AV fistula

A

A. Congenital

B. Acquired

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6
Q

Congenital Etiology of AV fistula

A
  1. Robertson’s Giant Limb

2. Cirsoid aneurysm of the scalp “Arterial hemangioma”

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7
Q

Robertson’s Giant Limb in Congenital Etiology of AV fistula

A
  • Alternative name

* Pathogenesis

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8
Q

Alternative name of Robertson’s Giant Limb in Congenital Etiology of AV fistula

A

Klippel-Trenaunay syndrome

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9
Q

Pathogenesis of Robertson’s Giant Limb in Congenital Etiology of AV fistula

A
  • Affecting mainly the lower limb with multiple A.V fistula mainly in the bones
  • Causing local gigantism
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10
Q

Cirsoid aneurysm of the scalp in Congenital Etiology of AV fistula

A
  • Alternative name
  • Common sites
  • Associations
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11
Q

Alternative name of Cirsoid aneurysm of the scalp in Congenital Etiology of AV fistula

A

Arterial hemangioma

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12
Q

Common sites of Cirsoid aneurysm of the scalp in Congenital Etiology of AV fistula

A
  • Temporal region : in relation to the superficial temporal artery
  • Occipital regions of the scalp.
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13
Q

Associations of Cirsoid aneurysm of the scalp in Congenital Etiology of AV fistula

A

Sometimes it has intracranial connections

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14
Q

Clinical picture of AV fistula

A

A) Local characters

B) Effects on the Limb

C) Effects on the circulation

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15
Q

Local characters in Clinical picture of AV fistula

A
  • Similarities to true aneurysm If there is a swelling

* Differences between Varicose aneurysm and true aneurysm

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16
Q

Similarities to true aneurysm If there is a swelling in Local characters in Clinical picture of AV fistula

A
  • Smooth, rounded, cystic & compressible with expansile pulsation
  • In the line of an artery.
  • Movable across, but not along that artery
  • Compressing the proximal artery reduces its size and stops its pulsation, thrill and bruit.
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17
Q

Differences between Varicose aneurysm and true aneurysm in Local characters in Clinical picture of AV fistula

A
  • Timing of thrill and bruit

* Propagation of thrill and bruit

18
Q

Timing of thrill and bruit in Varicose aneurysm

A

Overlying systolic & diastolic

19
Q

Timing of thrill and bruit in true aneurysm

A

Overlying only systolic

20
Q

Propagation of thrill and bruit in Varicose aneurysm

A

propagated distally and proximally.

21
Q

Propagation of thrill and bruit in true aneurysm

A

propagated distally only.

22
Q

Effects on the Iimb in Clinical picture of AV fistula

A
  1. Local overgrowth (gigantism)
  2. Chronic ischemia
  3. Pulsatile varicose veins
23
Q

Local overgrowth (gigantism) in Effects on the Iimb in Clinical picture of AV fistula

A
  • Affected type of AV fistula

* Pathogenesis

24
Q

Affected type of AV fistula in Local overgrowth (gigantism) in Effects on the Iimb in Clinical picture of AV fistula

A

only in congenital type especially if widespread.

25
Q

Pathogenesis of Local overgrowth (gigantism) in Effects on the Iimb in Clinical picture of AV fistula

A

It is due to increase oxygenation and nutrition through the leg.

26
Q

Pathogenesis of Chronic ischemia in Effects on the Iimb in Clinical picture of AV fistula

A

due to decrease arterial blood flow.

27
Q

Pathogenesis of Pulsatile varicose veins in Effects on the Iimb in Clinical picture of AV fistula

A

due to increase venous flow.

28
Q

Effects of AV fistula on the circulation in Clinical picture of AV fistula

A
  1. Hyperdynamic circulation
  2. The Branham’s bradycardic reaction :
  3. Later ventricular hypertrophy & high cardiac output failure occur.
29
Q

Pathogenesis of Hyperdynamic circulation in Effects of AV fistula on the circulation in Clinical picture of AV fistula

A

A-V fistula produces :

  • Increased venous return.
  • Increased cardiac output.
  • Tachycardia & high pulse pressure.
30
Q

The Branham’s bradycardic reaction in Effects of AV fistula on the circulation in Clinical picture of AV fistula

A

Compressing the artery proximal to the fistula causes bradycardia (Branham’s sign).
due to Dec venous return to the heart

31
Q

INVESTIGATIONS OF AV fistula

A
  • ACQUIRED FISTULA

* CIRSOID ANEURYSM OF THE SCALP

32
Q

ACQUIRED FISTULA investigation in INVESTIGATIONS OF AV fistula

A
  1. Doppler study or duplex scan

2. Arteriography.

33
Q

Doppler study or duplex in ACQUIRED FISTULA INVESTIGATIONS OF AV fistula

A

can localize the site of the fistula.

34
Q

CIRSOID ANEURYSM OF THE SCALP investigations in INVESTIGATIONS OF AV fistula

A
  1. Plain X-Ray skull

2. External carotid angiography

35
Q

Plain X-Ray skull in CIRSOID ANEURYSM OF THE SCALP investigations in INVESTIGATIONS OF AV fistula

A

Rarified bone.

36
Q

External carotid angiography in CIRSOID ANEURYSM OF THE SCALP investigations in INVESTIGATIONS OF AV fistula

A

To detect any intracranial connections

37
Q

Treatment of AV fistula

A
  • Congenital AV fistula

* Acquired AV fistula

38
Q

Congenital AV fistula Treatment in Treatment of AV fistula

A
  1. Robertson’s Giant Limb

2. Cirsoid aneurysm

39
Q

Treatment of Robertson’s Giant Limb in Congenital AV fistula Treatment in Treatment of AV fistula

A

Usually stationary & needs no operative interference.

40
Q

Treatment of Cirsoid aneurysm in Congenital AV fistula Treatment in Treatment of AV fistula

A
  • Surgical excision under general hypotensive anesthesia

* Preliminary therapeutic embolization by gelfoam of the feeding vessels may be tried.

41
Q

Acquired AV fistula Treatment in Treatment of AV fistula

A
  1. Excision and vascular repair of both artery & vein.

2. Quadruple ligation

42
Q

Quadruple ligation in Acquired AV fistula Treatment in Treatment of AV fistula

A

The artery & vein are ligated above & below the fistula

Done if the above operation is difficult due to extensive adhesions in a peripheral unimportant artery.

Surgery.(General 2).Vascular (16 decks)

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