Iatrogenic Arteriovenous Fistula After Revascularization of the Hand

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.

Arteriovenous fistula - replantation - revascularization

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