WordNet

an abnormal passage leading from a suppurating cavity to the body surface (同)sinus
connecting an artery to a vein; "an arteriovenous fistula"

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瘻(ろう)菅(長い菅状になった潰瘍)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/11/11 23:12:08」(JST)

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An arteriovenous fistula is an abnormal connection or passageway between an artery and a vein. It may be congenital, surgically created for hemodialysis treatments, or acquired due to pathologic process, such as trauma or erosion of an arterial aneurysm.

Causes

Illustration of Arteriovenous Fistula

Congenital (developmental defect)
Rupture of arterial aneurysm in adjacent vein
Penetrating injuries
Inflammatory necrosis of adjacent vessels
Intentionally created (for example, Cimino fistula as vascular access for hemodialysis)

Pathophysiology

When an arteriovenous fistula is formed involving a major artery like the abdominal aorta, it can lead to a large decrease in peripheral resistance. This lowered peripheral resistance causes the heart to increase cardiac output to maintain proper blood flow to all tissues. The physical manifestations of this would be a relatively normal systolic blood pressure with a decreased diastolic blood pressure resulting in a wide pulse pressure.

Normal blood flow in the brachial artery is 85 to 110 milliliters per minute (mL/min). After the creation of a fistula, the blood flow increases to 400—500 mL/min immediately, and 700—1,000 mL/min within 1 month. A bracheocephalic fistula above the elbow has a greater flow rate than a radiocephalic fistula at the wrist. Both the artery and the vein dilate and elongate in response to the greater blood flow and shear stress, but the vein dilates more and becomes "arterialized". In one study, the cephalic vein increased from 2.3 mm to 6.3 mm diameter after 2 months. When the vein is large enough to allow cannulation, the fistula is defined as "mature." ^[1]

An arteriovenous fistula can increase preload.^[2]

Complications

Just like berry aneurysm, an intracerebral arteriovenous fistula can rupture causing subarachnoid hemorrhage.^[3]

Associated conditions

Hereditary hemorrhagic telangiectasia

References

^ Vascular, Vol. 14, Supl. 1, Nov. 2006, p. S1
^ "Pulmonary: Heart Failure". Archived from the original on 1 February 2009. Retrieved 2008-12-21.
^ Pediatric cardiology for practitioners (4. ed.). St. Louis [u.a.]: Mosby. 2002. ISBN 0323014445. |first1= missing |last1= in Authors list (help)

External links

Arteriovenous Fistula at Merck Manual
Overview at Mayo Clinic

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UpToDate Contents

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1. 血液透析用の動静脈痩形成 creating an arteriovenous fistula for hemodialysis
2. 長期血液透析用の動静脈瘻および動静脈グラフト arteriovenous fistulas and grafts for chronic hemodialysis access
3. 新たに形成された血液透析動静脈瘻の成熟および評価 maturation and evaluation of the newly created hemodialysis arteriovenous fistula
4. 発達した血液透析用動静脈痩障害 failure of the mature hemodialysis arteriovenous fistula
5. 発達した血液透析用動静脈痩の検査 examination of the mature hemodialysis arteriovenous fistula

English Journal

Arteriovenous fistula stent infection diagnosed with radiolabelled leucocyte scintigraphy.

Yoo JR1, Heo ST, Kim M, Kim HW, Chang JW, Song H.
Infectious diseases (London, England).Infect Dis (Lond).2015 Jul;47(7):510-4. doi: 10.3109/00365548.2014.1002108. Epub 2015 Mar 13.
Infectious complications of haemodialysis in patients with arteriovenous fistula stent are rare. In addition, patients with low-grade infection are more difficult to diagnose. Here, we report the first case of low-grade infection of an arteriovenous fistula stent diagnosed using (99m)Tc-hexamethylpr
PMID 25768230

Multiple coronary fistulae to left ventricle, with acute myocardial infarction.

Uyar IS1, Akpinar B2, Senarslan O3, Sahin V2, Uc H2.
Asian cardiovascular & thoracic annals.Asian Cardiovasc Thorac Ann.2015 Jun;23(5):561-3. doi: 10.1177/0218492314522045. Epub 2014 Jan 30.
A rare case of myocardial infarction secondary to multiple coronary artery fistulae is described. Coronary angiography showed the fistulae originating from the distal septal branch of the left anterior descending artery and distal branches of the right coronary and circumflex arteries, and drained i
PMID 24585292

Four-dimensional computed tomography angiographic evaluation of cranial dural arteriovenous fistula before and after embolization.

Tian B1, Xu B2, Lu J3, Liu Q4, Wang L5, Wang M6.
European journal of radiology.Eur J Radiol.2015 Jun;84(6):1144-9. doi: 10.1016/j.ejrad.2015.03.009. Epub 2015 Mar 18.
PURPOSE: This study aimed to evaluate the usefulness of four-dimensional CTA before and after embolization treatment with ONYX-18 in eleven patients with cranial dural arteriovenous fistulas, and to compare the results with those of the reference standard DSA.PATIENTS AND METHODS: Eleven patients wi
PMID 25818730

Japanese Journal

Evaluating the Need for and Effect of Percutaneous Transluminal Angioplasty on Arteriovenous Fistulas by Using Total Recirculation Rate per Dialysis Session (“Clearance Gap”)

Ugawa Toyomu,Sakurama Kazufumi,Yorifuji Takashi,Takaoka Munenori,Fujiwara Yasuhiro,Kabashima Narutoshi,Azuma Daisuke,Hirayama Takahiro,Tsukahara Kohei,Morisada Sunao,Iida Atsuyoshi,Tada Keitaro,Shiba Naoki,Sato Nobuo,Ichiba Shingo,Kino Koichi,Fukushima Masaki,Ujike Yoshihito
Acta Medica Okayama 66(6), 443-447, 2012-12
… The functioning of an arteriovenous fistula (AVF) used for vascular access during hemodialysis has been assessed mainly by dilution methods. … We assessed the correlation between Kt/V and CL-Gap as well as the change in radial artery (RA) blood flow speed in the fistula before percutaneous transluminal angioplasty (PTA) in 45 patients undergoing continuous hemodialysis. …
NAID 120005082626

自己血管内シャントにおける脱血不良発生と超音波検査における機能評価および形態評価との関連性

山本裕也,中村順一,中山祐治 [他]
日本透析医学会雑誌 45(11), 1021-1026, 2012-11
NAID 40019507221

肺動静脈瘻を切除したRendu-Osler-Weber病

瀬川正孝,峠正義,関功二 [他]
胸部外科 65(10), 862-865, 2012-09
NAID 40019416599

「AVF」

Arteriovenous fistula
	Classification and external resources
ICD-10	I28.0, I77.0
ICD-9	414.19, 417.0, 447.0, 747.3
DiseasesDB	32435
eMedicine	med/169
MeSH	D001164