Arteriovenous Fistulas - Types & Treatment (2024)

An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein. When there is a fistula in the brain, we call it an arteriovenous malformation (AVM). When a fistula occurs near the dura (the covering material of the brain), it is a dural arteriovenous fistula. Sometimes AVFs are present at birth (congenital) or develop after birth, and sometimes they are the result of an injury (acquired).

An AVF can occur anywhere in the body, though we mostly find them in the head, neck, spine, and liver. The connection between a high-pressure artery and a low-pressure vein can increase the blood flow through the area, which often expands both the artery and the vein. Often, people with an AVF experience some swelling, pulsing, or vibration in the spot where the AVF is. When a doctor listens to the location with a stethoscope, there is often a bruit, or continuous murmur.

Here are some of the most common forms of artervenous fistulas:

  • Acquired arteriovenous fistulasare not present at birth. They usually happen when a sharp object goes through your body tissue, such as during a gunshot or stabbing injury. These rarely result from a medical procedure.
  • Arteriovenous fistulasin the face or neck cause swelling and abnormal pulsing. In extreme cases among infants, it can overload the heart. They rarely cause serious problems with brain development.
  • Dural arteriovenous fistulasoccur within the dura, which covers the brain. Sometimes we see symptoms at birth while other times, the condition does not become apparent until later in childhood. A large dural AVF can cause cardiac failure at birth. Smaller ones can cause increase in the pressure in the veins inside the head, resulting inhydrocephalusor enlargement of the cerebral ventricles (spaces within the brain that hold fluid). A dural AVF can also cause a bruit, or a pulsing noise or, less often, bleeding or damage to the brain tissue.
  • Peripheral arteriovenous fistulasoccur outside of the head, neck, and spine. When present at birth, these are most likely in the liver (called hepatic AVF). There are two types of hepatic AVF. A fistula between the hepatic (liver) artery and the hepatic vein is called a hepatic AVF and one between the hepatic artery and the portal vein (the vein that conducts blood from the veins draining the bowel to the liver) is an arterioportal fistula. Both types of AVF can occur within an infantile hemangioma.
  • Pial or cerebral arteriovenous fistulasoccur in the brain. A large one can cause heart failure at or even before birth. Smaller ones can damage the brain around the fistula because it diverts blood flow away from the brain tissue and into the draining vein. We treat these conditions as soon as we discover them, to minimize the amount of brain damage. Some cerebral AVFs rupture, causing bleeding in the brain.
  • Spinal arteriovenous fistulashappen in or next to the spinal cord, within the spine, or in the muscles adjacent to the spine. These fistulas can compress the spinal cord, leading to numbness or weakness.
  • Vein of Galen arteriovenous fistulasusually appear in infancy or early childhood. They drain into the vein of Galen, which is part of the deep venous drainage system of the brain. These fistulas can cause cardiac failure,hydrocephalus,or damage to the developing brain.

Treatment Options

Like arteriovenous malformations, we can treat arteriovenous fistulas with endovascular embolization,microsurgery, or stereotactic radiosurgery. Our multidisciplinary team, which evaluates every complex case, will determine the best approach for you. This team consists of experts in all of our treatment approaches, so can work together to prescribe the safest, most effective treatment plan for your arteriovenous fistula without bias towards one particular treatment.

  • Endovascularembolization is the most common form of treatment for an AVF. We perform this procedure by inserting a catheter into an artery (usually the femoral artery in the front of the hip). Then, guided by fluoroscopic or X-ray imaging, we move it to the location of the fistula. We inject contrast so that we can see the exact location of the AVF. Then we inject material into the exact location where the artery and the vein meet, to stop the blood flow. We use a variety of types of devices, including coils, detachable balloons, embolization glue, embolization particles, embolization material (called Onyx), and vascular plugs. Once we have closed the connection between the artery and the vein, the AVF is cured and usually does not reoccur.

Occasionally, when the fistula happens between the side of an important artery and the vein next to it, we insert a coveredstent(a wire mesh tube covered with fabric) into either the artery or the vein. This technique typically cures the AVF while keeping the artery and vein intact. A third option is to surgically close the fistula.

  • Microsurgery is the most appropriate treatment for a dural, brain, or spinal AVF, either alone or in combination with endovascular embolization. We usually can tell you before we begin treatment if we think microsurgery will be necessary. With microsurgery, we perform a neurosurgery to visualize the AVF under a microscope and we place a titanium clip over the abnormal connection to prevent blood from flowing abnormally from the artery to the vein. During the procedure, we can see the abnormal blood flow stop and the abnormal vein changes from red (when it is carrying arterial blood) to blue, which is the normal color of veins. Immediately after the procedure, we usually repeat the angiogram to confirm that the AVF has been completely treated.
  • Stereotactic radiosurgery is appropriate if an AVF is located too close to important brain structures for us to safely perform embolization or microsurgery. This is a painless, outpatient procedure that takes place in the radiation oncology department. We position a stereotactic head frame on you using lidocaine. Music therapy makes the process as comfortable and pain-free as possible. Once the head frame is in place, you undergo acomputed tomography (CT) scanof the head. The treatment is very similar to a CT scan and often lasts about 30 minutes. Then we remove the head frame and you can go home.
Arteriovenous Fistulas - Types & Treatment (2024)


What are the three types of AV fistulas? ›

The three most common AVFs are the radiocephalic fistula, the brachiocephalic fistula, and the brachial artery–to–transposed basilic vein fistula. Although many potential access site stenoses can and do occur within any given fistula, each fistula has a characteristic site of stenosis.

What is the most common arteriovenous fistula? ›

The most common arteriovenous fistula techniques include the radiocephalic fistula, brachiocephalic fistula, and transposed brachiobasilic fistula.

How do you treat an arteriovenous fistula? ›

Minimally invasive endovascular embolization — This technique is typically sufficient to repair the majority of AVFs. During this procedure, the surgeon passes a catheter through the groin up into the arteries in the brain that lead to the AVF and inject a glue-like liquid into these arteries.

What is the rule of 6 for AV fistula? ›

Objective: The Rules of 6 (flow volume >600 mL/min, vein diameter >6 mm, vein depth <6 mm) are widely used to determine when an arteriovenous fistula (AVF) will support dialysis.

What is the survival rate for AV fistula? ›

As dural arteriovenous fistulas aren't common, research is still ongoing to learn more about survival rates. Current studies report that the annual mortality rate (the number of people who die due to this condition) is between 11% and 19%. This estimates the annual survival rate to be above 80% in certain cases.

What are the 4 types of fistulas in ano? ›

In 1976, Dr. Parks published a paper describing a classification system for anal fistulas that is still widely used today. Four types were described: intersphincteric, transsphincteric, suprasphincteric, and extrasphincteric.

Why do AV fistulas get so big? ›

Over time, your fistula should get larger, extending past the lines drawn on your arm when your access was created. This allows more blood to flow through the fistula and into the vein in order to provide a high enough blood flow rate during your hemodialysis treatments.

What is the most complication of AV fistula? ›

Heart failure.

This is the most serious complication of large arteriovenous fistulas. Blood flows more quickly through an arteriovenous fistula than it does through typical blood vessels. The increased blood flow makes the heart pump harder. Over time, the strain on the heart can lead to heart failure.

Can an AV fistula be reversed? ›

Removal of symptomatic AVFs is a safe and beneficial procedure in patients with a functioning renal transplant. Removal of large asymptomatic fistulas should be considered in patients with a normally functioning renal transplant and other autogenous access options in the event of graft failure.

What should you not do with a fistula? ›

If you can't feel it you must contact your unit or renal ward the same day. Do not let anything obstruct the blood flow in your arm– do not allow your blood pressure to be taken on your fistula arm and do not wear constricting clothes or jewellery.

What is the recovery time for an arteriovenous fistula? ›

Arteriovenous fistulas can take between 6-12 weeks to mature and arteriovenous grafts can generally be used 2-3 weeks after surgery.

What can you not do with AV fistula? ›

Important Long-term Precautions for Fistula or Graft Access
  • Do not let anyone draw blood or put an IV in your access arm. ...
  • Do not have your blood pressure taken in your access arm.
  • Do not wear a tight sleeve, a watch, or other constricting jewelry on your access arm.

How do you unblock AV fistula? ›

The IR doctor uses a substance called a contrast agent that shows on X-rays to help find the blockage or narrowing in your AV fistula. They then treat the blockage by stretching the blood vessels with a special balloon.

How painful is AV fistula surgery? ›

How is the AV fistula procedure performed? A surgeon usually performs the procedure in the operating room. You receive a local anesthetic (numbing medicine) at the proposed site along with IV sedation to relax you. Discomfort is minimal and you may even fall asleep during the 1 to 2 hour-long procedure.

How do you keep AV fistula healthy? ›

You play an important part in keeping your fistula healthy.
  1. Do not take blood pressure measurements from your fistula arm.
  2. Do not have any blood tests taken from your fistula arm.
  3. No needles, infusions, or drips are to go into your fistula arm.
  4. Do not wear any tight or restrictive clothing on your fistula arm.

What are the common types of AV fistula? ›

There are 3 basic types of AVF dialysis:
  • Radial Cephalic fistula.
  • Brachial Cephalic.
  • Brachial Basilic Transposition.
Jun 22, 2016

What are the different types of AV fistula sites? ›

Two such options exist. First is a brachial-cephalic fistula, which is an anastomosis between the brachial artery and the cephalic vein in the proximal forearm. The second is a brachial-basilic fistula, which is an anastomosis between the brachial artery and the basilic vein in the upper arm.

What are the types of aortic fistula? ›

There are two different types of AEF:
  • Primary: Occurs when a chronic, untreated aortic aneurysm damages or destroys the aortic and bowel tissue.
  • Secondary: Occurs due to inflammation of previous aortic graft surgery that is near a section of bowel. This type is more common than primary AEF.

What is the most common coronary artery fistula? ›

The most common type of this anomaly arises from the RCA (60% of cases) and empties into the right ventricle. The next most frequently encountered type involves drainage of the LAD artery into the pulmonary trunk. In these types of fistula, a left-to-right shunt is formed to create a high-cardiac output state.

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