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 Arteriovenous Malfomations and Arteriovenous Fistulate

Michael A. Golden, M.D., James C. Stanley, M.D., Thomas C. Naslund , M.D.

Includes:

  • Surgical, Catheter and Nonoperative Management of Angiodysplasias

I. Anatomy and Pathophysiology

1. To understand the pathophysiology of arteriovenous malformations (AVM) and arteriovenous fistulae (AVF). This includes the rare forms (congenital and acquired) and the more common forms (traumatic and iatrogenic) of arteriovenous communications.

2. To define the influences of age, location, presenting symptoms and past medical, surgical and traumatic history on the etiology of arteriovenous communications, and to recognize the importance of syndromes with AVM.

3. To understand the common risk factors for the development of acquired arteriovenous communications, and how to anticipate and minimize the risks.

4. To understand the clinical settings associated with congenital AVM and to recognize them without delay.

5. To understand the early and the late important hemodynamic properties and effects of arteriovenous communications, and the effects of these changes on perfusion.

6. To understand the adaptive responses to the abnormal hemodynamics associated with arteriovenous communications.

7. To understand the natural history of arteriovenous communications as a function of the type of communication, (etiology, location, size, comorbidity and complications).

8. To understand the principles for the creation of arteriovenous communications for therapeutic indications, such as dialysis access, and distal extremity bypass grafts and venous bypass grafts.

9. To understand the technical considerations for the creation of arteriovenous communications for therapeutic indications, such as dialysis access, and distal extremity bypass grafts and venous bypass grafts.

10. To understand the complications and problems with therapeutic arteriovenous communications.

II . Diagnostic Evaluation

1. To understand the patterns of presentation of patients with arteriovenous malformations (AVM) and arteriovenous fistulae (AVF). This includes the rare forms (congenital and acquired) and the more common forms (traumatic and iatrogenic) of arteriovenous communications.

2. To understand the role of history and physical examination in the diagnosis of arteriovenous communications.

3. To define appropriate, cost effective diagnostic testing for arteriovenous communicatons .

4. To understand the role of the vascular diagnostic laboratory for the diagnostic evaluation of arteriovenous communications.

5. To understand the role of magnetic resonance imaging and magnetic resonance angiography for the diagnostic evaluation of arteriovenous communications.

6. To understand the role of contrast angiography for the diagnostic evaluation of arteriovenous communications.

7. To understand the role of diagnostic studies for the selection of the patient and site, and the preparation for the creation of a therapeutic arteriovenous communication.

8. To understand the diagnostic evaluation of the complications and problems with therapeutic arteriovenous communications.

III. Treatment

1. To understand the role of conservative management for arteriovenous communications.

2. To understand the role of catheter based intervention in the treatment of arteriovenous communications.

3. To understand the role of open surgery in the treatment of arteriovenous communications.

4. To understand the interactions of the treatments and the expected impact of combinations of treatments of arteriovenous communications.

5. To understand the principles for the creation of arteriovenous communications for therapeutic indications, such as dialysis access, and distal extremity bypass grafts and venous bypass grafts.

6. To understand the technical considerations for creation of arteriovenous communications, for therapeutic indications, such as dialysis access, and distal extremity bypass grafts and venous bypass grafts.

7. To understand the complications and problems with therapeutic arteriovenous communications.

8. To understand the advantages and disadvantages of therapeutic AVF.

References

1. Congenital vascular defects and hemangiomas , Rutherford RB, Loose DA ( eds ): Seminars in Vascular Surgery, Philadelphia , WB Sanders, 1993, Vol 6, No 4.

2. Thomas S. Riles, M.D.: Overview. Arteriovenous communications and congenital vascular malformations. In Rutherford RB ( ed ): Vascular Surgery. 4th ed Vol 2, Philadelphia , WB Sanders, 1995 pp 1163-1165.

3. David S. Sumner, M.D.: Hemodynamics and Pathophysiology of Arteriovenous Fistulae. Arteriovenous communications and congenital vascular malformations. In Rutherford RB ( ed ): Vascular Surgery. 4th ed Vol 2, Philadelphia , WB Sanders, 1995 pp 1166-1191.

4. Robert B. Rutherford, M.D. and David S. Sumner, M.D.: Diagnostic Evaluation of Arteriovenous Fistulae. Arteriovenous communications and congenital vascular malformations. In Rutherford RB ( ed ): Vascular Surgery. 4th ed Vol 2, Philadelphia , WB Sanders, 1995 pp 1192-1206.

5. William H. Baker, M.D.: Arteriovenous Fistulae of the Aorta and its Major Branches. Arteriovenous communications and congenital vascular malformations. In Rutherford RB ( ed ): Vascular Surgery. 4th ed Vol 2, Philadelphia , WB Sanders, 1995 pp 1207-1210.

6. Thomas S. Riles, M.D., Robert J. Rosen, M.D. and Alejandro Berenstein , M.D.: Peripheral Arteriovenous Fistulae. Arteriovenous communications and congenital vascular malformations. In Rutherford RB ( ed ): Vascular Surgery. 4th ed Vol 2, Philadelphia , WB Sanders, 1995 pp 1211-1217.

7. Robert J. Rosen, M.D., Thomas S. Riles, M.D. and Alejandro Berenstein , M.D.: Congenital Vascular Malformations. Arteriovenous communications and congenital vascular malformations. In Rutherford RB ( ed ): Vascular Surgery. 4th ed Vol 2, Philadelphia , WB Sanders, 1995 pp 1218-1232.

8. Timothy P. Connall , M.D. and Samuel E. Wilson, M.D.: Vascular Access for Hemodialysis . Angioaccess . In Rutherford RB ( ed ): Vascular Surgery. 4th ed Vol 2, Philadelphia , WB Sanders, 1995 pp 1233-1244.

9. John D. Bennett M.D. and Saadoon Kadir , M.D.: Renal Arteriovenous Malformation and Arteriovenous Fistula. In Current Therapy in Vascular Surgery. Ernst CB , Stanley JC ( eds ): 3rd ed, St. Louis , MI , Mosby , 1995 pp 830-333.

10. Robert B. Rutherford, M.D.: Classification of Peripheral Congenital Vascular Malformations. In Current Therapy in Vascular Surgery. Ernst CB , Stanley JC ( eds ): 3rd ed, St. Louis , MI , Mosby , 1995 pp 834-838.

11. William H. Pearce, M.D. and Robert L. Vogelzang , M.D.: Evaluation of Congenital Vascular Malformations of the Extremities by Nonangiographic Methods. In Current Therapy in Vascular Surgery. Ernst CB , Stanley JC ( eds ): 3rd ed, St. Louis , MI , Mosby , 1995 pp 839-840.

12. S. Martin Lindenauer , M.D.: Acquired Arteriovenous Fistula. In Current Therapy in Vascular Surgery. Ernst CB , Stanley JC ( eds ): 3rd ed, St. Louis , MI , Mosby , 1995 pp 841-845.

13. Steven R. Buchman , M.D. and David J. Smith, Jr., M.D.: Congenital Vascular Lesions in Infancy and Childhood. In Current Therapy in Vascular Surgery. Ernst CB , Stanley JC ( eds ): 3rd ed, St. Louis , MI , Mosby , 1995 pp 846-849.

14. Thomas S. Riles, M.D. and Mark A. Adelman , M.D.: Management of Congenital Arteriovenous Fistulas and Malformations in Adults. In Current Therapy in Vascular Surgery. Ernst CB , Stanley JC ( eds ): 3rd ed, St. Louis , MI , Mosby , 1995 pp 850-852.

15. Jeffrey L. Buehrer , M. D. and Blair A. Keagy , M.D.: Direct Arteriovenous Anastomosis for Angioaccess . In Current Therapy in Vascular Surgery. Ernst CB , Stanley JC ( eds ): 3rd ed, St. Louis , MI , Mosby , 1995 pp 857-859.

16. Richard W. Dow, M.D. and Sheldon A. Schwartz, M.D.: Bridge Grafts for Angioaccess . In Current Therapy in Vascular Surgery. Ernst CB , Stanley JC ( eds ): 3rd ed, St. Louis , MI , Mosby , 1995 pp 860-864.

17. Armen Vartany , M.D., Martin J. Winkler, M.D., and Samuel E. Wilson, M.D.: Surveillance of Angioaccess Graft Function. In Current Therapy in Vascular Surgery. Ernst CB , Stanley JC ( eds ): 3rd ed, St. Louis , MI , Mosby , 1995 pp 865-867.

18. B. O. Anderson, M.D., R. B. Rutherford, M.D. and D.E. Szilagy , M.D.: Congenital vascular malformations of the extremities. In Vascular Surgery: A Comprehensive Review, Moore WS ( ed ): Philadelphia , WB Saunders, 1991, 3rd ed, pp 131-140.

19. R. S. Bennion , M.D., and S.E. Wilson, M.D.: Hemodialysis and Vascular Access. In Vascular Surgery: A Comprehensive Review, Moore WS ( ed ): Philadelphia , W.B. Sanders, 1991, 3rd ed, pp 537-559.

Posted June 2010