title: Arteriovenous fistula of the groin in a drug abuser with endocarditis.
abstract: Intravenous drug abusers commonly develop endocarditis due to injection of particulate matter that can cause endothelial damage to the valves. The frequent need to access the venous system can result in vascular traumas with potential complications including arteriovenous (AV) fistulas. Here, we present the case of an intravenous drug abuser with endocarditis and an unusually large AV fistula in the groin. The patient was successfully operated for endocarditis. However, the AV fistula was at the time not acknowledged. The combination of ileofemoral vein thrombosis and a large AV fistula led to pulmonary septic embolism and life-threating, right-sided heart failure. Computed tomography scan did not reveal the AV fistula, but suspicion was raised. Ultrasound diagnosed and revealed the magnitude of the AV fistula, and the patient was treated with a minimally invasive percutaneous technique.
authors.affiliation: Department of Infectious Diseases, University of Bergen, Bergen, Norway solveig.aalstad.jonasson@helse-bergen.no.
authors.forename: Solveig Aalstad
authors.initials: SA
authors.lastname: Jonasson
authors.affiliation: Department of Radiology, University of Bergen, Bergen, Norway.
authors.forename: Dag Eirik
authors.initials: DE
authors.lastname: Jøssang
authors.affiliation: Section of Cardiothoracic Surgery, Department of Heart Disease, University of Bergen, Bergen, Norway Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
authors.forename: Rune
authors.initials: R
authors.lastname: Haaverstad
authors.affiliation: Department of Infectious Diseases, University of Bergen, Bergen, Norway.
authors.forename: Øystein
authors.initials: Ø
authors.lastname: Wendelbo
authors.affiliation: Department of Vascular Surgery, Haukeland University Hospital, Bergen, Norway.
authors.forename: Gustav
authors.initials: G
authors.lastname: Pedersen
references.citation: Circulation. 2005 Jun 14;111(23):e394-434
references.pmid: 15956145
references.citation: J Vasc Surg. 2007 Nov;46(5):906-12
references.pmid: 17905558
references.citation: Eur Heart J. 2009 Oct;30(19):2369-413
references.pmid: 19713420