WordNet

the 1st letter of the Roman alphabet (同)a
the blood group whose red cells carry the A antigen (同)type_A, group A
an abnormal passage leading from a suppurating cavity to the body surface (同)sinus

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answer / ampere
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）』「2012/10/21 16:17:51」(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.

Vascular access for hemodialysis

Main article: Cimino fistula

A radiocephalic fistula.

Patients with end stage renal failure are treated with hemodialysis. In dialysis, blood is withdrawn from an artery or vein, purified, and returned to a vein. The volume of blood is too great for veins to handle, so a vein must be enlarged. An artery and vein, usually in the arm above or below the elbow, are sewn together, to create a fistula, and arterial pressure eventually enlarges the vein. The enlarged vein can accommodate a cannula or large needle.

Physiology

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 (large) 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 to 500 mL/min immediately, and 700 to 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]

References

^ Vascular, Vol. 14, Supl. 1, Nov. 2006, p. S1
^ "Pulmnary: Heart Failure". Archived from the original on 1 February 2009. http://www.indyrad.iupui.edu/rtf/teaching/medstudents/stf/pul1/pul1.htm. Retrieved 2008-12-21.

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. 下肢の後天性動静脈瘻 acquired arteriovenous fistula of the lower extremity
5. 血液透析用の動静脈グラフトおよび動静脈痩の狭窄および血栓性合併症の治療の概要 overview of the treatment of stenosis and thrombotic complications of hemodialysis arteriovenous grafts and fistulas

English Journal

Computational model for simulation of vascular adaptation following vascular access surgery in haemodialysis patients.

Manini S1, Passera K, Huberts W, Botti L, Antiga L, Remuzzi A.Author information 1a Department of Biomedical Engineering , Mario Negri Institute for Pharmacological Research , Bergamo , Italy.AbstractAn important number of surgical procedures for creation of vascular access (VA) in haemodialysis patients still results in non-adequate increase in blood flow (non-maturation). The rise in blood flow in arteriovenous shunts depends on vascular remodelling. Computational tools to predict the outcome of VA surgery would be important in this clinical context. The aim of our investigation was then to develop a 0D/1D computational model of arm vasculature able to simulate vessel wall remodelling and related changes in blood flow. We assumed that blood vessel remodelling is driven by peak wall shear stress. The model was calibrated with previously reported values of radial artery diameter and blood flow after end-to-end distal fistula creation. Good agreement was obtained between predicted changes in VA flow and in arterial diameter after surgery and corresponding measured values. The use of this computational model may allow accurate vascular surgery planning and ameliorate VA surgery outcomes.
Computer methods in biomechanics and biomedical engineering.Comput Methods Biomech Biomed Engin.2014 Sep;17(12):1358-67. doi: 10.1080/10255842.2012.745857. Epub 2013 Jan 3.
An important number of surgical procedures for creation of vascular access (VA) in haemodialysis patients still results in non-adequate increase in blood flow (non-maturation). The rise in blood flow in arteriovenous shunts depends on vascular remodelling. Computational tools to predict the outcome
PMID 23281788

Onyx embolization of cavernous sinus dural arteriovenous fistulas via direct transorbital puncture under the guidance of three-dimensional reconstructed skull image (reports of six cases).

Liu A1, Liu J, Qian Z, Peng T, Li Y, Yang J, Wu Z, Jiang C.Author information 1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, TiantanXili 6, Dongcheng District, Beijing, 100050, China, liuaihua_ttyy@126.com.AbstractBACKGROND: Because of complex angioarchitecture, the transarterial or venous pathway is not feasible for some cavernous sinus dural arteriovenous fistulas (CS DAVFs). We present six cases in which onyx embolization of a CS DAVFs was made possible through direct transorbital puncture.
Acta neurochirurgica.Acta Neurochir (Wien).2014 May;156(5):897-900. doi: 10.1007/s00701-014-2037-5. Epub 2014 Mar 6.
BACKGROND: Because of complex angioarchitecture, the transarterial or venous pathway is not feasible for some cavernous sinus dural arteriovenous fistulas (CS DAVFs). We present six cases in which onyx embolization of a CS DAVFs was made possible through direct transorbital puncture.METHODS: In the
PMID 24595539

Percutaneous device closure of abernethy malformation-A treatable cause of hepatopulmonary syndrome.

Venkateshwaran S1, Krishnamoorthy KM, Sivasankaran S.Author information 1Department of Cardiology, Sreechitra Tirunal Institute For Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.AbstractAn eight-year-old girl was evaluated for unexplained cyanosis. A contrast echo was suggestive of pulmonary arteriovenous fistula. Further evaluation revealed Abernethy malformation (type 2) leading to hepatopulmonary syndrome. Percutaneous device closure of Abernethy malformation was done after anatomical and physiological evaluation of the portal circulation. Prior to closure, it is important to ensure adequate portal radicals into the liver and normal portal pressure after test balloon occlusion. Subcostal echocardiography can diagnose and guide device closure of Abernethy malformation, a treatable cause of hepatopulmonary syndrome. © 2013 Wiley Periodicals, Inc.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.Catheter Cardiovasc Interv.2014 May 1;83(6):968-70. doi: 10.1002/ccd.25275. Epub 2013 Nov 19.
An eight-year-old girl was evaluated for unexplained cyanosis. A contrast echo was suggestive of pulmonary arteriovenous fistula. Further evaluation revealed Abernethy malformation (type 2) leading to hepatopulmonary syndrome. Percutaneous device closure of Abernethy malformation was done after anat
PMID 24248907

Japanese Journal

Ipsilateral Jugular to Distal Subclavian Vein Transposition to Relieve Central Venous Hypertension in Rescue Vascular Access Surgery: A Surgical Report of 3 Cases

Acri IgnazioE,Carmignani Amedeo,Vazzana Giovanni,Massara Mafalda,Acri Edvige,Lentini Salvatore,Spinelli Francesco
Annals of Thoracic and Cardiovascular Surgery 2012(0), 2012
… However, if an arteriovenous (AV) fistula is prepared below the obstructed venous segment, then symptoms may occur. … However, in some cases endovascular treatment may not be as easy and long term patency uncertain.We report our experience on 3 patients on chronic hemodialysis treatment presenting with a patent AV fistula and ipsilateral subclavian vein chronic fibrotic obstruction. …
NAID 130002148283

著しい低酸素血症を来した右肺全域におよぶ肺動静脈瘻の1例

朴幸男,大谷肇,大石千尋,佐藤大祐,上山敬直,山本克浩,岩坂潤二,岩坂壽二
日本心臓病学会誌 =Journal of cardiology. Japanese edition 5(3), 228-231, 2010-10-15
NAID 10027704666

頭蓋頸椎移行部dural AV fistulaの外科治療

西村真実,高沢弘樹,井上智夫,沼上佳寛,林央周,西嶌美知春,冨永悌二
脳卒中の外科 35(6), 446-450, 2007-11-30
… Spinal dural arteriovenous fistula (AVF) is the most common type of spinal vascular malformations. …
NAID 110006478592

「連続性雑音」

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