Your doctor will use a stethoscope to listen to the blood flow in your arms and legs. The blood flow through an arteriovenous fistula makes a sound similar to humming.
If your doctor suspects a fistula, you'll have other tests to confirm your diagnosis. Tests to diagnose an arteriovenous fistula can include:
- Duplex ultrasound. Duplex ultrasound is the most effective and common way to check for an arteriovenous fistula in your legs or arms. In duplex ultrasound, sound waves are used to evaluate the speed of blood flow.
- Computerized tomography (CT) angiogram. A CT angiogram can show if blood flow is bypassing the capillaries. Before the test starts, you'll receive an injection of a dye (contrast) that makes your blood vessels show up more clearly on CT images.
- Magnetic resonance angiography (MRA). Your doctor may use this test if he or she thinks you have an arteriovenous fistula deep under your skin. Like an MRI, an MRA uses a magnetic field and radio waves to create pictures of the body's soft tissues. However, you're also given a special dye that helps create images of your blood vessels.
If your arteriovenous fistula is small and doesn't cause any other health problems, you may need only close monitoring by a doctor. Some small arteriovenous fistulas close by themselves without treatment.
If your arteriovenous fistula requires treatment, your doctor may recommend:
- Ultrasound-guided compression. This may be an option for you if you have an arteriovenous fistula in your legs that's easily seen on ultrasound. In this treatment, an ultrasound probe is used to compress the fistula and block blood flow to the damaged blood vessels. This procedure takes about 10 minutes. But it only works for about 1 in 3 people.
- Catheter embolization. In this procedure, a catheter is inserted in an artery near the arteriovenous fistula. Doctors use X-rays and other images to guide the catheter to your fistula. Then, a small coil or stent is placed at the site of your fistula to reroute your blood flow. Many people who have catheter embolization stay in the hospital for less than a day and can resume daily activities within a week.
- Surgery. Large arteriovenous fistulas that can't be treated with catheter embolization may require surgery. The type of surgery you'll need depends on the size and location of your arteriovenous fistula.
Preparing for your appointment
If you think you may have an arteriovenous fistula, make an appointment with your primary care doctor. You may be referred to a blood vessel (vascular) specialist or heart specialist (cardiologist).
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and know what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. Since tests for an arteriovenous fistula usually include an ultrasound, it's possible you'll need to fast for several hours before your appointment.
- Write down any symptoms you're experiencing, including any that may seem unrelated to an arteriovenous fistula.
- Write down key personal information, including previous piercing injuries or a family history of arteriovenous fistula or other blood vessel diseases.
- Make a list of all medications, vitamins or supplements that you're taking.
- Take a family member or friend along, if possible. Sometimes it can be difficult to recall all of the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. For arteriovenous fistula, some basic questions to ask your doctor include:
- What's the most likely cause of my symptoms?
- Are there any other possible causes for my symptoms?
- What kinds of tests will I need?
- What treatments are available, and which do you recommend?
- What's an appropriate level of physical activity?
- I have other health conditions. How can I best manage these conditions together?
- Should my children or other biological relatives be screened for this condition?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous, or do they come and go?
- How severe are your symptoms?
- Does anything seem to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
June 19, 2020
- Jameson JL, et al., eds. Arterial diseases of the extremities. In: Harrison's Principles of Internal Medicine. 20th ed. The McGraw-Hill Companies; 2018. https://accessmedicine.mhmedical.com. Accessed April 16, 2020.
- Stone CK, et al., eds. Vascular emergencies. In: Current Diagnosis & Treatment: Emergency Medicine. 8th ed. McGraw-Hill Education; 2017. https://accessmedicine.mhmedical.com. Accessed April 16, 2020.
- Eidt J, et al. Acquired arteriovenous fistula of the lower extremity. https://www.uptodate.com/contents/search. Accessed April 16, 2020.
- Cameron AM, et al., eds. Pseudoaneurysms and arteriovenous fistulas. In: Current Surgical Therapy. 13th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed April 16, 2020.
- Gossage JR, et al. Pulmonary arteriovenous malformations: Clinical features and diagnostic evaluation in adults. https://www.uptodate.com/contents/search. Accessed April 16, 2020.
- Mankad R (expert opinion). Mayo Clinic. May 1, 2020.
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