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About Arteriovenous Fistulas

Medically reviewed by John A. Moawad, MD, FACS — By Jill Seladi-Schulman, Ph.D. on September 30, 2022An arteriovenous fistula (AVF) is when an abnormal connection forms between an artery and a vein. This can affect the circulation of blood in the affected area. Arteries carry oxygen-rich blood away from your heart and into the tissues of your body via the capillaries, the tiniest of blood vessels. Veins bring oxygen-depleted blood back to the heart. Arteriovenous fistulas can disrupt this process and cause various complications. This article will explain what causes arteriovenous fistulas, how to recognize symptoms, and how they’re diagnosed and treated.

What is an arteriovenous fistula

With an arteriovenous fistula (AVF), an abnormal connection has formed between an artery and a vein. Because of this, blood can move freely between these two blood vessels, bypassing the capillaries and impacting healthy circulation. AVFs can be found in any area of the body. However, some locations may be more common, depending on the type of AVF. There are two general types of AVF: Congenital: Congenital AVFs are present from birth. Acquired: Acquired AVFs are those that develop over the course of your lifetime.

What causes an arteriovenous fistula

There are several potential causes of AVFs depending on the type.

Congenital

Congenital AVFs are present from birth. They’re rare but can occur due to irregularities that happen while a fetus is developing in the womb. It’s also possible for congenital AVFs to develop due to a genetic condition. Some genetic conditions that can cause AVF formation include hereditary hemorrhagic telangiectasia (spider veins) and capillary malformation-arteriovenous malformation syndrome. Some general areas where congenital AVFs may be found include, but aren’t limited to, the:heartlungsbrainliver Congenital AVFs usually aren’t treated unless they become symptomatic, often later in adulthood.

Acquired

Acquired AVFs develop during your lifetime. This can occur due to trauma from surgery or an injury. These types of AVFs develop at or near the site of the trauma. There are certain types of procedures that are more likely to be associated with AVF formation. Some examples include cardiac catheterization and needle biopsy. AVFs due to injury typically happen due to a penetrating wound. Examples include gunshot wounds and stab wounds. They can also occur due to bone fractures or serious head injuries. In some cases, an AVF may be surgically made for hemodialysis. This helps to make the hemodialysis process more efficient. AVFs for this purpose are typically created in the arm.

What are the symptoms of an arteriovenous fistula

Not all AVFs cause symptoms. When symptoms are present, they can depend on the location of the AVF. Let’s take a look at some potential symptoms based on location.Limbs: An AVF in an extremity, such as an arm or leg, may lead to symptoms like pain and swelling of the affected area. In some cases, the affected limb can appear larger and have varicose veins.Heart: AVFs can cause your heart to work harder to pump blood to the rest of your body. As such, people with AVFs near the heart and in other areas of the body may show signs consistent with heart failure, such as:fatigueshortness of breathexercise intolerancefluid buildup in the body (edema)Lung: If an AVF affects the lung, it may lead to symptoms like:shortness of breathcoughing up bloodlips and fingernails that are pale, blue, or grey in color, depending on your skin toneBrain: AVFs in or around the brain can lead to:severe headachenausea or vomitingtinnitusbulging of the eyesvision problemsseizuresissues with language and speechcoordination difficultiesLiver: An AVF in the liver can cause symptoms like:abdominal painblood in the stoolascitesKidney: When an AVF is around the kidneys, it can lead to flank pain and blood in the urine. If you have symptoms consistent with an AVF, see your doctor for an evaluation. While your symptoms may not be due to an AVF, they could be due to another medical condition.

How is an arteriovenous fistula diagnosed

The diagnostic process will start with a physical exam and medical history. During this exam, your doctor will take your vital signs and evaluate your symptoms. They’ll also ask about things like:when your symptoms startedhow severe your symptoms are and if anything makes them better or worseif you have a personal or family history of any medical conditionswhether you’ve had a significant surgery or injury in the pastwhich types of medications and supplements you use Afterward, your doctor may order the following tests to see if you have an AVF.

Duplex ultrasound

A duplex ultrasound uses two types of ultrasound technology. It allows your doctor to look at how blood flows through your blood vessels.

Angiography

Angiography creates images of your blood vessels that your doctor can use to look at the structure of your blood vessels and how blood flows through them. It often involves the injection of a special dye to help with contrast. More traditional angiography involves the use of X-rays and the insertion of a catheter. There are also less invasive options available, such as those that use CT scan and MRI scan.

How is an arteriovenous fistula treated

If you have an AVF that’s not causing symptoms, you may not need treatment right away. Instead, your doctor may choose to monitor it periodically. This is called conservative management. The treatment of an AVF typically involves a procedure to repair the abnormal connection. This is often done using an endovascular method. Endovascular repair involves the insertion of a catheter into the affected blood vessel. This is then used to aid in the placement of a stent, coil, or foam that closes the AVF and helps to direct blood flow. An open surgery can also be used to repair AVFs. This involves opening the affected blood vessel with an incision. This type of procedure is less common, as it’s associated with more risks and a longer recovery time.

Are there complications associated with an arteriovenous fistula

AVFs can lead to a variety of complications. However, early treatment can help prevent these.Venous hypertension: Venous hypertension is when the blood pressure in the veins is higher than normal. Eventually, this can result in venous insufficiency. This is where the veins have trouble returning blood back to your heart.Bleeding: Veins have very thin walls. In some cases, the wall of a vein in an AVF may rupture, leading to potentially serious bleeding in the body.Steal syndrome: This is when oxygen levels are reduced in the affected area, due to large amounts of blood passing through the AVF. It can lead to tissue death and damage.Heart failure: An AVF can cause the heart to work harder to pump blood throughout the body. This can lead to heart failure in rare cases.

The bottom line

An AVF is when an abnormal connection develops between an artery and a vein. It can either be congenital or acquired. AVFs can happen anywhere in the body. The symptoms of an AVF can vary based on where in the body it’s located. While some AVFs don’t cause any symptoms, others can lead to severe or life threatening complications. However, with early diagnosis and treatment, the outlook for many AVFs is generally good. Last medically reviewed on September 30, 2022

How we vetted this article

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Capillary malformation-arteriovenous malformation syndrome. (2011).
medlineplus.gov/genetics/condition/capillary-malformation-arteriovenous-malformation-syndrome/El Youbi S, et al. (2022). Surgical management of a congenital arteriovenous fistula of the forearm.
academic.oup.com/jscr/article/2022/6/rjac259/6603579Eldine RN, et al. (2020). Management of dual traumatic arteriovenous fistula from a single shotgun injury: A case report and literature review.
bmcsurg.biomedcentral.com/articles/10.1186/s12893-020-00833-5Facts about hereditary hemorrhagic telangiectasia (HHT). (2022).
cdc.gov/ncbddd/hht/index.htmlHartley JL, et al. (2019). High-output cardiac failure secondary to high-output arteriovenous fistula: Investigations, management, and treatment. [Abstract].
casereports.bmj.com/content/13/2/e233669Jayroe H, et al. (2021). Arteriovenous fistula.
ncbi.nlm.nih.gov/books/NBK559213/Li G, et al. (2020). Congenital subclavian-superior vena cava arteriovenous fistula with initial stenosis in an adult: A case report.
bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-020-01660-5Nair A, et al. (2010). Posttraumatic intra-hepatic A-V fistula and the development of portal hypertension.
journals.lww.com/ajg/Fulltext/2010/10001/Posttraumatic_Intra_Hepatic_A_V_Fistula_and_the.794.aspxPerinjelil V, et al. (2018). Traumatic arteriovenous fistula formation secondary to crush injury.
ncbi.nlm.nih.gov/pmc/articles/PMC6149232/Van den Broecke M, et al. (2020). Renal arteriovenous fistula.
ncbi.nlm.nih.gov/pmc/articles/PMC6993596/Zyck S, et al. (2022). Dural arteriovenous fistula.
ncbi.nlm.nih.gov/books/NBK532274/Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Sep 30, 2022 By Jill Seladi-Schulman, PhD Edited By Rosalie Rung Medically Reviewed By John Moawad, MD Copy Edited By Suan Pineda Share this articleMedically reviewed by John A. Moawad, MD, FACS — By Jill Seladi-Schulman, Ph.D. on September 30, 2022

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