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CLINICAL STUDY: CARDIAC CATHETERIZATION

Incidence and clinical outcome of iatrogenic femoral arteriovenous fistulas

Implications for risk stratification and treatment

^* Department of Medicine, Division of Cardiology, Pulmonary Disease and Angiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

Manuscript received January 25, 2002; revised manuscript received March 4, 2002, accepted April 17, 2002.

^* Reprint requests and correspondence: Dr. Malte Kelm, Heinrich-Heine-Universität Düsseldorf, Medizinische Klinik und Poliklinik B, Klinik für Kardiologie, Pneumologie und Angiologie, Moorenstraße 5, D-40225 Düsseldorf, Germany.
kelm{at}med.uni-duesseldorf.de

OBJECTIVES: We sought to determine the incidence of arteriovenous fistulas (AVF), identify risk factors for AVF, and follow up the clinical outcome of femoral AVF.

BACKGROUND: Arteriovenous fistulas are a potential harmful complication of cardiac catheterization. Incidence and clinical outcome of iatrogenic AVF are unknown so far, although important for risk stratification and treatment.

METHODS: A total of 10,271 consecutive patients undergoing cardiac catheterization were followed up prospectively over a period of three years. Diagnosis of AVF was performed by duplex sonography.

RESULTS: The incidence of AVF was 0.86% (n = 88). The following significant and independent risk factors for AVF were identified: high heparin dosage (odds ratio [OR]) = 2.88), coumadin therapy (OR = 2.34), puncture of the left groin (OR = 2.21), arterial hypertension (OR = 1.86), and female gender (OR = 1.84). Within 12 months 38% of all AVF closed spontaneously. No signs of cardiac volume overload or limb damage were observed in patients with persisting AVF. None of the risk factors for AVF influenced the incidence or the rate of AVF closure. Only intensified anticoagulation showed a tendency to extend AVF persistence.

CONCLUSIONS: Almost 1% of patients undergoing cardiac catheterization acquire femoral AVF, for which patient- and procedure-related risk factors could be identified. One-third of iatrogenic AVF close spontaneously within one year. Cardiac volume overload and limb damage are highly unlikely with AVF persistence. Thus, a conservative management for at least one year seems to be justified.

Abbreviations and Acronyms   ACT   activated clotting time   AVF   arteriovenous fistula/fistulas   BMI   body mass index   CI   confidence interval   ECG   electrocardiogram   F   French (catheter size of 0.3 mm/F)   I50   interquartile distance   INR   international normalized ratio   IU   international units   MHz   megahertz   OR   odds ratio   PCI   percutaneous coronary intervention

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