ULTRASOUND DIAGNOSTICS OF TRAUMATIC ARTERIOVENOUS

FISTULAS IN COMBAT TRAUMA

 

Golovushkina G.V., Aseeva I.A., Troyan V.N., Zamsky K.S., Petrov K.Yu.

 

N.N. Burdenko Main Military Clinical Hospital, Ministry of Defense of the Russian Federation. Moscow, Russia.

P

urpose. To improve the efficiency of ultrasound diagnostics of traumatic arteriovenous fistulas obtained in combat trauma.

Materials and Methods. During the ultrasound examination of the main vessels of the limbs in 500 wounded patients, the damage of the main vessels with the formation of arteriovenous fistula was diagnosed in 59 (11.8%) of them. The causes of arteriovenous fistulas were mine-explosive wounds. All patients at the hospital stage underwent ultrasound scanning of the main vessels of the extremities, computed tomography with bolus contrast enhancement and angiography. Localization of traumatic arteriovenous fistulas was distributed as follows: in 11 patients (19%) arteriovenous fistula of the upper extremities was detected, in 48 (81%) – of the lower extremities. There was predominantly isolated damage of the lower limbs arteries – 32 (67%), including common femoral – 5 (16%), deep femoral – 2 (7%), superficial femoral – 11 (34%), hamstring – 11 (34%), peroneal – 3 (9%). Combined arteriovenous fistulas of the lower limbs arteries were also diagnosed in 16 (33%) wounded patients: anterior tibial and peroneal arteries – 7 (44%), posterior tibial and peroneal arteries – 9 (56%). Upper limb arteries were affected: subclavian artery – 2 (18%), axillary artery – 2 (18%), brachial artery – 7 (64%).

Results. The data of our ultrasound study indicate an increase in diastolic and volumetric blood flow velocities, a decrease in peripheral resistance in the studied vascular basin. The study of deep veins showed a significant increase in their diameter, linear and volumetric blood flow velocities compared to the contralateral side. Significant local increase in systolic and diastolic blood flow velocities was a diagnostic criterion for the presence of arteriovenous junction.

Discussion. During ultrasound examination of the main vessels of the extremities, a direct sign of the presence of arteriovenous fistula is the visualization of the fistulous accessory, defined as a high-speed blood jet in the color Dopplerography mode, that is, the so-called ellizing effect, and in the constant-wave Dopplerography mode – the registration of arterialized blood flow through the vein and a decrease in peripheral resistance in the artery.

Conclusion. Early diagnosis of arteriovenous fistulas facilitates patient treatment and improves prognosis. Ultrasound scanning allows noninvasive diagnosis of arteriovenous fistulas, recording hemodynamic parameters in the vessels under study, as well as reducing time, outlining the optimal treatment plan and reducing the number of complications.

 

Keywords: arteriovenous fistula, arteriovenous junction, arterialization of blood flow.

 

Corresponding author: Golovushkina G.V., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Golovushkina G.V., Aseeva I.A., Troyan V.N., Zamsky K.S., Petrov K.Yu. Ultrasound diagnostics of traumatic arteriovenous fistulas in combat trauma. REJR 2024; 14(4):132-140. DOI: 10.21569/2222-7415-2024-14-4-132-140.

Received: 15.07.24                 Accepted: 22.10.24