Browsing by Subject "Arteriovenous fistula"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Arteriovenous Fistula Rescues Radial Forearm Phalloplasty: A Case Report on Patients with Microvascular Obstruction
    (American Society of Plastic Surgeons, 2021-05-21) Santucci, Richard A.; Newsom, Keeley D.; Wachtman, Galen S.; Crane, Curtis N.; Medicine, School of Medicine
    Radial forearm free flap phalloplasty (RFFFP) is the most common surgery performed for genital reconstruction of female-to-male transgender patients. However, up to 19% require anastomotic re-exploration. The postoperative creation of an arteriovenous fistula (AVF) to bypass obstruction and salvage RFFFP was first reported in 1996 and has subsequently been reported by 1 high-volume center in Belgium. Methods: Here, we present 2 cases in which intraoperative microvascular obstruction threatened the viability of the RFFF of transgender phalloplasty patients. In each patient, an AVF was created between the radial artery and cephalic vein in the distal flap either after being transferred out of the operating room, as has previously been described, or during initial operation. Results: In both cases, the creation of a distal AVF salvaged the neophallus. Importantly, the patient that had been transferred out of the operating room before reintervention suffered partial flap necrosis compared with no flap loss in the patient who had an AVF created during initial surgery. One AVF was ligated 18 days postoperative, whereas the other was never formally closed. Conclusions: These cases demonstrate that AVF can be reliably used for RFFFP salvage both intraoperatively and for reintervention. They also suggest that earlier detection of persistent vascular compromise and utilization of AVF can further minimize flap loss. Finally, in contrast with the prior explanation of this technique, timing of AVF ligation may be less critical than previously described. Microsurgeons are reminded that this technique may save complicated flaps in the uncommon case of microcirculatory flap obstruction.
  • Thumbnail Image
    Item
    Delayed presentation of a traumatic scalp arteriovenous fistula
    (Scientific Scholar, 2021-05-25) Ordaz, Josue D.; Villelli, Nicolas W.; Bohsntedt, Bradley N.; Ackerman, Laurie L.; Neurological Surgery, School of Medicine
    Background: Arteriovenous (AV) fistulas of the scalp are extracranial vascular malformations commonly caused by trauma and typically present within 3 years. Although they follow a benign course, they can be esthetically displeasing. Case description: We present an atypical onset of scalp AV fistula in a patient with a 1-year history of the left-sided pulsatile tinnitus and scalp swelling 7 years after a traumatic epidural hematoma evacuation. Our patient was found to have an 8 mm AV fistula supplied by the deep temporal artery. Endovascular embolization was performed using eight coils. There was no complication from the procedure, and the patient's pulsatile tinnitus and swelling resolved immediately after embolization. Follow-up angiogram demonstrated complete obliteration of the AV fistula. Conclusion: Delayed presentation of traumatic scalp AV fistula is very rare, and it is important to keep this in the differential in patients with scalp swelling after head trauma.
  • Thumbnail Image
    Item
    Moving Beyond the Assumed: Improving Fistula Success Rates
    (American Society of Nephrology, 2017-10) Wish, Jay B.; Moe, Sharon M.; Medicine, School of Medicine
    Comment on Intimal Hyperplasia, Stenosis, and Arteriovenous Fistula Maturation Failure in the Hemodialysis Fistula Maturation Study. [J Am Soc Nephrol. 2017] Histopathology of Veins Obtained at Hemodialysis Arteriovenous Fistula Creation Surgery. [J Am Soc Nephrol. 2017]