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An incidental case of spontaneous common femoral artery to common femoral vein fistulation diagnosed by ultrasound.
EP34333
Poster Title: An incidental case of spontaneous common femoral artery to common femoral vein fistulation diagnosed by ultrasound.
Submitted on 29 Oct 2020
Author(s): Dr Sophie Wismayer, Mr Stephen Wolstenhulme, Dr Claire Ryan, Dr Michael Weston, Mr David Russell
Affiliations: Leeds Teaching Hospitals NHS Trust
Poster Views: 445
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Poster Information
Abstract: A patient, with a history of a swollen left lower leg, was referred for an ultrasound to differentiate between cellulitis and deep vein thrombosis (DVT). No DVT was found, however the ultrasound demonstrated gross leg oedema with retrograde pulsatile flow in the common femoral vein, superficial femoral vein, profunda femoral vein and popliteal vein. The common femoral vein was aneurysmal and deep collateral vessels were seen at this level.
The great saphenous vein and iliac veins were patent with normal anterograde flow. The iliac, femoral and popliteal arteries were patent with normal waveforms.
The retrograde pulsatile Spectral Doppler waveform in the deep venous circulation was compatible with an arteriovenous fistula as opposed to hyperdynamic circulation or venous valve incompetence. This is retrospectively apparent on computed tomography (CT) from six weeks prior. The patient is not aware of any history of puncture to the groin.
A CT angiogram was performed three weeks later, which showed extensive connections between the artery and vein, warranting referral to the vascular malformation service.
This case demonstrates an interesting and unexpected finding in a commonly performed examination. It is a valuable educational case for sonographers and radiologists, highlighting the Spectral Doppler waveform to be aware of when considering this differential.
Summary: An arteriovenous fistula or arteriovenous malformation is an uncommon diagnosis to make on ultrasound when performing a scan for suspected deep vein thrombosis. The Doppler waveform to be aware of is discussed.References: 1. Sarker, B., Top Tips For DVT Scans. [online] bmus.org. Available at: (https://www.bmus.org/education-and-cpd/cpd-resources/top-tips/top-tips-for-dvt-scans/) [Accessed 17 October 2020].
2. Alty, J. and Hoey, E., 2013. Practical Ultrasound: An Illustrated Guide. 2nd ed. pp.121-135.
3. Naringrekar, H., Sun, J., Ko, C. and Rodgers, S., 2018.It's Not All Deep Vein Thrombosis: Sonography of the Painful Lower Extremity With Multimodality Correlation. Journal of Ultrasound in Medicine, [online] 38(4), pp.1075-1089. Available at: (https://onlinelibrary.wiley.com/doi/full/10.1002/jum.14776) [Accessed 27 October 2020].
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