ARTERIOVENOUS-FISTULA OF THE JUGULAR-VEIN - DETECTION AND MONITORING BY COLOR-CODED DUPLEX SONOGRAPHY

A 71-year-old man presented with a pulsating swelling in the lower rig ht neck region. On clinical examination palpation revealed a local thr ill and auscultation the typical systolic vascular sounds. On sonograp hy the typical findings for an AV fistula with large widening of the j ugular vein and entry of an extremely rapid jet stream into the vein w ere detected. The entry point was under a venous valve whose movements apparently influenced the jet stream since the inflow was only seen i ntermittently and only in the systolic phase. The shunt volume of the fistula was apparently small: indirect signs of an arteriovenous short circuit could not be seen on duplex sonograph. The low-flow fistula w as not demonstrated by arterial DSA. Thus, the arterial sources could not be identified Sonographic monitoring over 5 years at first showed no changes while at the last follow-up the fistula was no longer detec table. The suspected cause of the arteriovenous fistula was a vascular wall perforation effected some years previously during insertion of a central venous catheter: We further assume that the anticoagulation t herapy with Marcumar started at that time had prevented spontaneous cl osure of the fistula over a period of several years. This case illustr ates the value of colour-coded duplex sonography for the differentiati on of pulsating tumors in the neck. In individual cases of AV fistulas with low shunt volumes the method is apparently superior even to angi ography.