J Reconstr Microsurg 2005; 21(5): 283-286
DOI: 10.1055/s-2005-871767
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Iatrogenic Arteriovenous Fistula After Revascularization of the Hand

Neil F. Jones1 , Erin E. Brown1 , Kayvan T. Khiabani1
  • 1Department of Orthopaedic Surgery and Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA
Further Information

Publication History

Accepted: February 10, 2005

Publication Date:
22 June 2005 (online)

ABSTRACT

This is the first report of an iatrogenic arteriovenous fistula complicating revascularization of an incomplete amputation of the hand, due to inadvertent anastomosis of the proximal radial artery to the distal cephalic vein. This resulted in a severely painful, massively swollen hand, which was initially diagnosed as an infection or poor venous outflow and eventually required a below-elbow amputation. This complication of replantation or revascularization should be preventable by carefully matching the thickness of the vessel wall and the diameter of the lumen, to avoid anastomosing a proximal artery to a distal vein.

REFERENCES

  • 1 Backman C, Nystrom A, Backman C, Bjerle P. Arterial spasticity and cold intolerance in relation to time after digital replantation.  J Hand Surg. 1993;  18B 551-555
  • 2 Backman C O, Nystrom A, Backman C, Bjerle P. Cold induced vasospasm in replanted digits: a comparison between different methods of arterial reconstruction.  Scand J Plast Reconstr Hand Surg. 1995;  29 343-348
  • 3 Griffin P A, Tan E, Katsaros J. Late arterial thrombosis in a replanted thumb: a case report.  J Reconstr Microsurg. 1989;  5 75-77
  • 4 Strauch B, Greenstein B, Goldstein R, Liebling R W. Problems and complications encountered in replantation surgery.  Hand Clin. 1986;  2 389-399
  • 5 Waikakul S, Sakkarnkosol S, Vanadurongwan V. Un-nanuntana A. Results of 1018 digital replantations in 552 patients.  Injury. 2000;  31 33-40
  • 6 Weinzweig N, Sharzer L A, Starker I. Replantation and revascularization at the transmetacarpal level: long- term functional results.  J Hand Surg. 1996;  21 877-883

Neil F JonesM.D. 

UCLA Hand Center, Department of Orthopaedic Surgery and Division of Plastic and Reconstructive Surgery

200 UCLA Medical Plaza, Suite 140

Los Angeles, CA 90095

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