Arteriovenous fistula

To diagnose an arteriovenous fistula, a health care provider may use a stethoscope to listen to the blood flow in the arms and legs. The blood flow through an arteriovenous fistula makes a sound like humming.

If your provider thinks you have a fistula, other tests are typically done to confirm the 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 the legs or arms. In duplex ultrasound, sound waves are used to evaluate the speed of blood flow.
• Computerized tomography (CT) angiogram. This imaging test can show if blood flow is bypassing the capillaries. Dye (contrast) is given by IV for this test. The dye helps blood vessels show up more clearly on the images.
• Magnetic resonance angiography (MRA). This test may be done if you have signs of an arteriovenous fistula deep under the skin. Like an MRI, an magnetic resonance angiography (MRA) uses a magnetic field and radio waves to create pictures of the body's soft tissues. Dye (contrast) is given by IV to help blood vessels show up better on the images.

If an arteriovenous fistula is small and doesn't cause any other health problems, close monitoring by a health care provider may be the only treatment needed. Some small arteriovenous fistulas close by themselves without treatment.

If an arteriovenous fistula requires treatment, your provider may recommend:

• Ultrasound-guided compression. This may be an option for an arteriovenous fistula in the legs that's easily seen on ultrasound. In this treatment, an ultrasound probe is push down on the fistula for about 10 minutes. The compression destroys blood flow to the damaged blood vessels.
• Catheter embolization. In this procedure, a thin, flexible tube (catheter) is inserted in an artery near the arteriovenous fistula. Then, a small coil or stent is placed at the site of the fistula to reroute 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 needed depends on the size and location of the arteriovenous fistula.

If you think you may have an arteriovenous fistula, make an appointment with your primary care provider. You may be referred to a doctor trained in blood vessel (vascular) or heart (cardiologist) diseases.

Appointments can be brief. 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 provider.

What you can do

• Write down any symptoms you're having, 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 fistulas or other blood vessel diseases.
• Make a list of all medications, vitamins or supplements that you're taking. Include their doses.
• Take a family member or friend along, if possible. Sometimes it can be difficult to recall all the information provided to you during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your health care provider.

For an arteriovenous fistula, some basic questions to ask 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 health care provider is likely to ask you many questions. Being ready to answer them may save time to go over any details you want to spend more time on. Your provider may ask:

• When did you first begin having symptoms?
• Do you always have symptoms, or do they come and go?
• How severe are the symptoms?
• Does anything seem to improve the symptoms?
• What, if anything, makes symptoms worse?