Varicose Veins of the lower Limb - Acquired arteriovenous fistula Factor
An arteriovenous fistula is the abnormal direct communication between an artery and a vein whereby the blood bypasses the capillary bed. Arteriovenous fistulas may be acquired or congenital.
Description
Acquired fistulas are always caused by an underlying illness or injury. They are either created to provide vascular access for haemodialysis or occur as a result of a penetrating injury such as a gunshot or knife wound or as complication of arterial catheterisation or surgical dissection. An infrequent cause is rupture of an arterial aneurysm into a vein. If an acquired arteriovenous fistula forms part of a surgical procedure it may be referred to as a ‘shunt’.
Congenital fistulas are the result of persistent embryonic vessels that fail to differentiate into arteries and veins. They may be associated with birthmarks, may be located in almost any organ of the body, and frequently occur in the extremities.
Note: Congenital arteriovenous fistula is not included as a factor in the varicose veins of the lower limb SoP.
Signs and symptoms
- Diagnosis of an arteriovenous fistula is usually evident on physical examination – a stethoscope over the fistula will usually detect its presence.
- A pulsatile (throbbing) mass is frequently palpable and skin temperature is higher over the fistula.
- Longstanding arteriovenous fistulas produce chronic venous insufficiency, including peripheral edema, large, tortuous varicose veins, and stasis pigmentation due to high venous pressure. Evidence of ischaemia may occur in the distal portion of the extremity.
- Large arteriovenous fistulas may result in an increased cardiac output with consequent cardiomegaly and high-output heart failure.
- Compression of a large arteriovenous fistula may cause reflex slowing of the heart rate (Nicoladoni-Branham sign).
- Arteriography can confirm the diagnosis and is useful in determining treatment which may involve surgery, radiotherapy, or embolization.
- Acquired arteriovenous fistulas are usually amenable to surgery involving division or excision of the fistula. Occasionally, autogenous or synthetic grafting is necessary to re-establish continuity of the artery and vein.
Establishing onset
- The onset of an acquired arteriovenous fistula should be readily identified because of its distinctive clinical features and because it is always a by-product or complication of some underlying disease or injury.
- Medical records may be unavailable; in such cases a reliable history will generally be accepted, unless there is contradictory evidence. Seek medical advice if the evidence is unclear.
LAST REVIEWED FOR CCPS 30 JUNE 1999.
INVESTIGATIVE DOCUMENTS
| Type | Title | PDF Format | Word Format |
|---|---|---|---|
| Medical Report | Acquired Arteriovenous Fistula - Varicose Veins of the Lower Limb |
PRELIMINARY QUESTIONS [725]
8468 there is some evidence that an acquired arteriovenous fistula may be a factor in the development or worsening of the condition under consideration.
735 the veteran has had an acquired arteriovenous fistula at some time.
4737 the veteran has had an acquired arteriovenous fistula involving the blood vessels supplying side and site of the body at some time.
8599 the veteran has had an acquired arteriovenous fistula involving the blood vessels supplying side and site of the body which occurred as a result of an illness or injury which is identifiable at some time.
8236 the veteran has established the causal connection between the acquired arteriovenous fistula and VEA service for varicose veins of the lower limb.
8237 the veteran had an acquired arteriovenous fistula involving the blood vessels supplying side and site of the body, which occurred as a result of the identified illness or injury, at the time of the clinical onset of the condition under consideration.
26895 the veteran has established the causal connection between the acquired arteriovenous fistula and VEA service for the clinical onset of varicose veins of the lower limb.
8238 the veteran has established the causal connection between the acquired arteriovenous fistula and operational service for the clinical onset of varicose veins of the lower limb.
or
8239 the veteran has established the causal connection between the acquired arteriovenous fistula and eligible service for the clinical onset of varicose veins of the lower limb.
or
8252 the clinical onset of the veteran's varicose veins of side and site of the body occurred after the end of the veteran's last period of VEA service.
8253 the veteran's varicose veins of side and site of the body permanently worsened.
26896 the veteran had an acquired arteriovenous fistula involving the blood vessels supplying side and site of the body, which occurred as a result of the identified illness or injury, at the time of the clinical worsening of the condition under consideration.
26897 the veteran has established the causal connection between the acquired arteriovenous fistula and VEA service for the clinical worsening of varicose veins of the lower limb.
26898 the veteran has established the causal connection between the acquired arteriovenous fistula and operational service for the clinical worsening of varicose veins of the lower limb.
or
26899 the veteran has established the causal connection between the acquired arteriovenous fistula and eligible service for the clinical worsening of varicose veins of the lower limb.
CLINICAL ONSET AND OPERATIONAL SERVICE [8238]
26900 the identified illness or injury which caused the acquired arteriovenous fistula involving the blood vessels supplying side and site of the body is causally related to operational service.
CLINICAL ONSET AND ELIGIBLE SERVICE [8239]
26901 the identified illness or injury which caused the acquired arteriovenous fistula involving the blood vessels supplying side and site of the body is causally related to eligible service.
CLINICAL WORSENING AND OPERATIONAL SERVICE [26898]
26900 the identified illness or injury which caused the acquired arteriovenous fistula involving the blood vessels supplying side and site of the body is causally related to operational service.
26902 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury which caused the acquired arteriovenous fistula involving the blood vessels supplying side and site of the body is causally related.
CLINICAL WORSENING AND ELIGIBLE SERVICE [26899]
26901 the identified illness or injury which caused the acquired arteriovenous fistula involving the blood vessels supplying side and site of the body is causally related to eligible service.
26903 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury which caused the acquired arteriovenous fistula involving the blood vessels supplying side and site of the body is causally related.