Discussion
Systemic arteriovenous fistulas (AVF) are rare but correctable vascular
abnormalities usually occurring following catheterization procedures,
surgery, trauma, or aneurysms; Spontaneous fistulas have occasionally
been described (10). There are cases reports of spontaneous
arteriovenous fistulas on different vessels in the absence of triggering
cause, subclavian artery and vein(10), superficial femoral artery and
vein (11), left common iliac artery and vein (12) and popliteal artery
and vein (4). The cause of spontaneous AVF formation may remain unknown
and may need further study. Causes of AVF can be categorized
irrespective of the vessel involved (Figure 2) for a simplified
approach. Spontaneous arteriovenous fistulas are rare in clinical
activity with very limited reports in the literature but it is crucial
to diagnose it promptly to prevent further complications including
complications including aneurysm, thrombus formation, and limb
ischemia.
There has been a case report of spontaneous superficial femoral artery
to femoral vein fistula in a 71-year-old female patient known to have
multiple sclerosis in the background after her presentation with acute
limb ischemia (11). There is a report of AVF in the right lower limb
following HIV arthritis (3). Spontaneous right leg popliteal AVF had
also been reported in a 79-year-old female where the cause remained
unclear (4). The patient presented in this article had chronic kidney
disease (CKD) on the background of hemodialysis (HD) for 2 years. The
clinical correlation between CKD and/or HD remains unknown but the CKD,
HD, uremia, and vasculopathy genes may contribute to the formation of
AVF through different mechanisms including vascular shear stress force,
blood stasis, and cellular immunity dysfunction or their synergy (13,
14). In conclusion, spontaneous arteriovenous fistula (AVF) could occur
as sequelae of chronic kidney disease or hemodialysis but other common
causes need to be excluded. Though there is a report of spontaneous
AVF, generally AVF needs intervention (5, 6, 15).
Conclusion : spontaneous arteriovenous fistula could occur as
sequelae of chronic kidney disease or hemodialysis but other common
causes need to be excluded