Diagnosis and treatment of acquired arteriovenous fistula after lower extremity deep vein thrombosis

Background: Deep vein thrombosis (DVT) is a rare cause of arteriovenous fistula (AVF). The pathogenesis of acquired AVF after DVT remains unclear, and publications focusing on therapy and follow-up are also inadequate. In this study, the diagnosis and treatment of 24 patients with acquired AVF in the lower extremity after DVT was reported. Methods: This is a retrospective study. We studied 24 patients with acquired AVF after DVT who were screened by ultrasound and confirmed by arteriography or computed tomographic arteriography (CTA) in our hospital. Treatments included simple compression therapy (SCT), venous hypertension-relieving therapy (VHRT) and transarterial embolization; VHRT included iliac vein stenting and Palma-Dale surgery (fem-fem bypass). Results: All 24 patients exhibited symptoms in the left lower extremity including swelling (24 cases, 100%), pain (14 cases, 58.33%), pigmentation (13 cases, 54.17%) and ulcers (8 cases, 33.33%). No cardiac enlargement or cardiac insufficiency was reported in any case. The initial ultrasound screening suggested PTS in all 24 cases, with arterialized waveform in veins in 24 cases and high-velocity turbulent flow within the fistulas in 16 cases. The AVF recurrence rate of embolization was 66.7% (4/6). In 7 patients who underwent SCT, the circumference difference of bilateral lower limbs at the 1-year follow-up was not significantly different from that before treatment (thigh, P=0.413; calf, P=0.478). In 14 patients who underwent VHRT, the circumference difference of bilateral lower limbs at the 1-year follow-up was significantly smaller than that before treatment (thigh, P=0.000; calf, P=0.001), and the follow-up difference value of the Venous Insufficiency Epidemiological and Economic Study-Quality of Life (VEINES-QOL) scores was significantly higher than that in the SCT group (1 month, P=0.012; 6 months, P=0.000; 1 year, P=0.000; 2 years, P=0.003). Conclusions: Ultrasound plays an important role in screening and diagnosing AVF. Iliac vein obstruction rather than AVF was most likely the primary cause of the symptoms. Due to the high recurrence rate of DVT, transarterial embolization of AVF is not effective; thus, VHRT should be recommended as the preferred treatment.