Iatrogenic arteriovenous fistula in the arm in an infant: diagnostic and therapeutic considerations

Abstract

Iatrogenic arteriovenous fistulas (AVF) are well described in adults; however, this complication is rarely described and reported in infants. We report the case of a 3-month-old infant with complicated gastroschisis requiring multiple venipunctures who presented with signs and symptoms suggestive of traumatic arteriovenous fistula. Ultrasound imaging confirmed the presence of a wide-necked AVF between the brachial artery and vein. The fistula was surgically repaired. This case report describes the clinical imaging and treatment options for infants with iatrogenic AVF.

FIGURE 1

Ventral view of the distal left upper extremity. The patient’s thumb is represented by the white arrow. Ecchymotic striae are seen with a circumferential distribution.

FIGURE 2

(A) Gray-scale US image in the antecubital region demonstrating a wide-neck communication between the brachial artery and vein. (B) Color Doppler image showing direct communication between the artery and vein. (C) Left brachial vein pulsed Doppler spectral analysis shows an arterial waveform confirming an arterial venous fistula.

FIGURE 3

Dissection of the fistula at the antecubital fossa. The proximal arm is located to the right of the picture. The blue vessel loops encircle the brachial veins. The white asterisk marks the aneurysmal dilatation of the fistula. The proximal brachial artery is highlighted by the solid white lines.