Role of Arteriovenous Anastomoses in Vascular Diseases of the Lower Extremity

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Abstract
The role of arteriovenous anastomoses (AVA) in vascular diseases of the lower extremity was studied in 410 patients by means of 593 serial femoral arteriograms. Based on a clinical and angiographic correlation, this investigation was carried out in 3 groups of vascular disorders. Group I: venous insufficiency (varicose veins, post-phlebitic syndrome); Group II: ischemic manifestations in the absence of organic vascular diseases; Group III: occlusive arterial diseases. Presence of A-V [atrio-ventricular] shunting was determined indirectly by premature visualization of veins during serial arteriography. In patients iif Group I opacification of the veins within 5 to 8 sec. occurred in 81%. The initial site of opacification in varicose veins was in the pedal vessels while in patients with postphlebitic syndrome it occurred around the ankle, the site of maximum venous stasis. In patients of Group II the site of initial venous opacification was in plantar vessels and onset was within 5 to 8 sec. in 89.4%. The site and rate of venous opacification in Group III were quite different from those in the 2 other groups. The initial visualization, within 5 to 8 sec, involved the deep femoral vein and its tributaries in 31.7% of the cases. Although the pathophysiology of A-V shunting in vascular diseases is not entirely clear, prolonged and diffuse patency of AVA may result in a syndrome of ischemia. A-V shunting in varicose veins appears to be secondary rather than an initiating cause. In the postphlebitic syndrome short-circuiting of the arterial blood may be responsible for ischemic complications superimposed upon venous stasis manifestations. In Group II. A-V shunting accounts for the ischemia in the absence of organic occlusive disease. In Group III, early proximal venous return results in hemodynamic changes leading to further deprivation of the already diminished distal arterial supply.