Incidence and clinical outcome of iatrogenic femoral arteriovenous fistulas: implications for risk stratification and treatment.
OBJECTIVE
We sought to determine the incidence of arteriovenous fistulas (AVF), identify risk factors for AVF, and follow up the clinical outcome of femoral AVF.


BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Kelm
Malte
M
Department of Medicine, Division of Cardiology, Pulmonary Disease and Angiology, Heinrich Heine University Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany. kelm@med.uni-duesseldorf.de
Perings
Stefan M
SM
Jax
Thomas
T
Lauer
Thomas
T
Schoebel
Frank C
FC
Heintzen
Matthias P
MP
Perings
Christian
C
Strauer
Bodo E
BE
D000368:Aged; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D006328:Cardiac Catheterization / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D005263:Femoral Artery / Q000002:abnormalities*; D005268:Femoral Vein / Q000002:abnormalities*; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012107:Research Design; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome