Congenital arteriovenous fistulas in the chest wall

The clinical manifestations of large congenital, haemodynamically significant arteriovenous fistulas in the chest wall, originating from the subclavian area, are described in three cases and the results of surgical treatment are reported. Symptoms related to arteriovenous shunting were present in all three, with precordial pain and/or cardiac dysrhythmia, dyspnoea and intermittent painful ischaemia of the upper extremity. Altogether 19 operations were performed. The symptoms disappeared when fistulas were excised, but returned when fistula recurred. Lasting healing (9 years) was achieved in only one patient, after extensive ligation of all fistulas in the chest wall and sceletation of the subclavian artery from its proximal to its distal extent.