RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.5999/aps.2020.01704
Micro-arteriovenous fistula in patients with lower limb lymphedema
![](https://www.thieme-connect.de/media/10.1055-s-00051611/202102/lookinside/thumbnails/10_5999_aps_2020_01704_219-1.jpg)
Background A micro-arteriovenous fistula (AVF) is a minute, short shunt between an artery and a vein that does not pass through a capillary. We investigated the association between micro-AVFs and lymphedema using computed tomography angiography (CTA) and venous blood gas analysis.
Methods In 95 patients with lower limb lymphedema, the presence or absence of early venous return (EVR) was compared between patients with primary and secondary lymphedema. Furthermore, we investigated the difference in the timing of edema onset in patients with secondary lymphedema with or without EVR using CTA. In 20 patients with lower limb lymphedema with confirmed early EVR in a unilateral lower limb, the partial pressure of oxygen (PO2) was compared between the lower limb with EVR and the contralateral lower limb.
Results Secondary lymphedema with or without EVR occurred at an average of 36.0±59.3 months and 93.5±136.1 months, respectively; however, no significant difference was noted. PO2 was 57.6±11.7 mmHg and 44.1±16.4 mmHg in the EVR and non-EVR limbs, respectively, which was a significant difference (P=0.005).
Conclusions EVR and venous blood gas analysis suggested the presence of micro-AVFs in patients with lower extremity edema. Further research is warranted to examine the cause of micro-AVFs, to advance technology to facilitate the confirmation of micro-AVFs by angiography, and to improve lymphedema by ligation of micro-AVFs.
Keywords
Lymphedema - Arteriovenous fistula - Venous insufficiency - Venous hypertension - Computed tomography angiographyPublikationsverlauf
Eingereicht: 24. August 2020
Angenommen: 11. November 2020
Artikel online veröffentlicht:
07. März 2022
© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
REFERENCES
- 1 Haimovici H. Role of A-V shunting in varicose veins: therapeutic implications. J Cardiovasc Surg (Torino) 1995; 36: 109-15
- 2 Muneta K, Okubo Y, Sawada Y. Sclerosing panniculitis in a patient with arteriovenous fistula of the lower leg and summary of 13 cases. Jpn J Clin Dermat 2017; 71: 419-23
- 3 Tanaka M, Serizawa F, Nagaoka Y. et al. Two cases of micro-arteriovenous fistula in the lower extremity with misdiagnosis of refractory cellulitis. Ann Vasc Dis 2018; 11: 148-52
- 4 Serizawa F, Tanaka M, Shimizu T. et al. The epidemiology of micro-arteriovenous fistulas in the lower legs. Ann Vasc Surg 2019; 56: 29-35
- 5 Sakuma H, Watanabe S, Kono H. A novel surgical approach for refractory secondary lymphedema of the lower extremity accompanying micro-arteriovenous fistula. Ann Vasc Surg 2020; 65: 284
- 6 Honda K, Komai H, Juri M. Micro-arteriovenous fistula of the lower extremities with severe skin lesions. J Jpn Coll Angiol 2006; 46: 73-8
- 7 Pratt GH. Arterial varices; a syndrome. Am J Surg 1949; 77: 456-60
- 8 Blalock A. Oxygen content of blood in patients with varicose veins. Arch Surg 1929; 19: 898-905
- 9 Fontaine R. Remarks concerning venous thrombosis and its sequelae. Surgery 1957; 41: 6-25
- 10 Yoshida Y, Fujita M. Shunt flow of arteriovenous fistulas from plantar artery. Phlebology 2011; 26: 32-4
- 11 Uehara A, Yamamoto K, Mishima T. et al. A case of venous reconstruction for common iliac vein occlusion and ipsilateral internal iliac arteriovenous fistulae. Jpn J Vasc Surg 2008; 17: 575-80
- 12 Takase S, Pascarella L, Lerond L. et al. Venous hypertension, inflammation and valve remodeling. Eur J Vasc Endovasc Surg 2004; 28: 484-93