title: Free-flap distal arteriovenous fistula: when to close it?
abstract: A distal arteriovenous fistula was created secondarily in an innervated radial forearm free flap, to salvage the neophallus in three female-to-male transsexuals. This resulted in permanent edema and an arterial thrill in the neophallus. The arteriovenous fistulas were closed after 6 weeks to 20 months. Acute endothelial damage with risk of thrombosis, due to ischemia and exposure to arterial blood pressure, may be expected to have been repaired 4 to 6 weeks after arterialization of the veins. Intimal thickening will have started by then, but a subsequent decrease in vascular luminal diameter may still be expected to be reversible. The authors conclude that ligation of the distal arteriovenous fistula may safely be performed some 6 weeks after the salvage procedure.
authors.affiliation: Department of Plastic Surgery, Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Hage
authors.forename: S
authors.initials: S
authors.lastname: Monstrey
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D004487:Edema / Q000209:etiology; D005260:Female; D005542:Forearm / Q000601:surgery; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D010413:Penis / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D013524:Surgical Flaps; D013924:Thrombophlebitis / Q000209:etiology; D014189:Transsexualism / Q000601:surgery*