Ultrasound-Guided Compression for Treatment of latrogenic Arteriovenous Fistulae

Pseudoaneurysms and arteriovenous fistulae (AVF) are the two most common vascular complications following percutaneous common femoral artery cannulation. Encouraged by favorable results using ultrasound-guided compression (UGC) to treat iatrogenic femoral pseudoaneurysms, we prospectively evaluated UGC for the treatment of iatrogenic AVF. AVF were identified in 13 patients between September 1, 1995 and March 31, 1997. Eleven agreed to a trial of UGC. UGC was continued for 60 minutes with color-flow duplex scanning to monitor the adequacy of compressions. There were 13 attempts to thrombose AVF in 11 patients. Two patients had unsuccessful UGC while anticoagulated. In both cases, a second UGC was unsuccessful after correction of the coagulation profile. Two types of AVF were identified. A “direct” communication between the adjacent walls of the artery and vein was present in 10 patients. The other patient had a 2-cm “indirect” fistulous tract between the artery and vein. Direct communications were associated with peak spectral flow velocities ranging from 128 to 500 cm/sec (mean, 331 cm/sec), whereas the peak spectral flow velocity in the patient with the fistulous tract was only 70 cm/sec. UGC was only successful in the patient with the indirect tract. No complications occurred as a result of these compressions. Of the 10 who failed UGC, nine underwent operative repair, with spontaneous closure observed in the remaining patient. UGC is not effective for AVF, which have a direct arteriovenous communication with high-velocity blood flow. UGC is most likely to be successful when there is an indirect fistulous tract with a low-flow velocity.