May 2017 – Arterial Venous Fistula
76 y/o female with a history of GSW (gunshot wound) in 1993 to left groin/thigh causing an AVF (arterial venous fistula). AVFs (indicated by the white arrow in Image 1) are an abnormal connection or passageway between arteries and veins that are in close proximity to one another. They can be congenital (present at birth), surgically created (for use in dialysis) or acquired pathologically through trauma (as in this case) or by erosion of an arterial aneurysm. Normal blood flow delivers nutrient rich and oxygenated blood from arteries to capillaries thus feeding the body’s tissues. AVFs bypass this process which can lead to serious complications including, but not limited: to varicose vessels, swelling, fatigue, decreased blood pressure to heart failure. Diagnostic testing for an AVF can include: US, CT, and MR. Highly trained technologists in the 3D Lab used data from a CT scan for post processing using specialized software. An Amplatzer Device can be seen at the red arrow in Image 2a. Amplatzer devices like those shown in Image 2b separate the oxygenated blood from the deoxygenated blood. The other dense objects scattered about are bullet fragments indicated by the black arrows in Image 2a. Innumerable prominent collaterals indicated by the blue arrows in Image 1 are easily visualized by using MIP (maximum intensity projection) reformatting. To help the radiologist and surgeon better examine the AVF, CPRs (curved planar reformats) applied by the technologist, track the vessel of interest thereby eliminating extraneous structures occluding the area of interest (Image 3).