Alt ekstremite arteriyovenöz fistülü

Özet

Alt ekstremite arteriyovenöz fistülleri travma (penetran veya künt) ya da iyatrojenik damar yaralanması sonrası gelişebilir. Zamanlaması uygun arteriyel faz BT anjiyografide komşu drene edici vende karşı tarafa göre asimetrik erken kontrastlanma tanıyı destekler; doğrudan arter-ven kanalı ayrıca görülebilir. BT anjiyografi fistülün anatomisini gösterebilir; eşlik eden psödoanevrizma veya aktif kontrast ekstravazasyonu gibi damar yaralanmalarını da ortaya koyabilir. Tanı konmamış travmatik AVF zamanla ekstremite şişliği, kronik venöz yetmezlik ve ileri olgularda yüksek debili kalp yetersizliğiyle ilişkili olabilir.

Faz ve pencere

Arteriyel faz tanısal

Zamanlaması uygun arteriyel edinimde komşu femoral veya popliteal vende karşı tarafa göre asimetrik erken kontrastlanma izlenir; doğrudan arter-ven ileti kanalı görülebilir.

Gecikmiş

Gecikmiş görüntülerde aktif kanamaya bağlı kontrast ekstravazasyonu sonraki fazlarda genişleyebilir; psödoanevrizma ise gecikmiş görüntülerde büyümez. AVF değerlendirmesinde arteriyel fazdaki erken venöz doluş aranır.

Önerilen pencereler: Anjiyo (G 600 / M 150), Yumuşak doku (G 400 / M 40).

BT bulguları

• Arter ile komşu ven arasında fistül ileti yapısının görülmesi
• Arteriyel fazda eşlik eden femoral/popliteal vende erken kontrast dolumu
• Fistül tarafındaki drene edici ven erken opaklaşır; kronik fistüllerde damar genişlemesi ve kollateraller görülebilir
• Fistül tarafında venöz kollateral damarlar görülebilir
• Fistül komşuluğunda psödoanevrizma kesesi görülebilir
• Travma zemininde damar dışına kontrast ekstravazasyonu

Normalde

Uygun zamanlı arteriyel fazda, AVF bulunan taraftaki eş venin erken ve asimetrik doluşu karşı tarafın eş veniyle karşılaştırılır. İki taraftaki eş venlerin doluşunu karşılaştır ve erken doluş varsa arteriyovenöz ileti bulgusunu araştır.

Ayırıcı tanı

Travmatik AVF’de arter ile ven arasındaki ileti ve arteriyel fazda erken venöz doluş tanıyı destekler.

Psödoanevrizma, komşu arterden kaynaklanan, arteriyel fazda arterle benzer kontrastlanan fokal bir kese olarak görülebilir.

Derin ven trombozunda ven lümeninde dolum defekti görülebilir; arteriyel fazda karşı tarafa göre asimetrik erken venöz opasifikasyon AVF lehine ayrı bir bulgudur.

Aktif arteriyel kanamada kontrast ekstravazasyonu sonraki fazlarda boyut ve yoğunluk bakımından artabilir; AVF’de arteriyel fazda erken venöz doluş görülür.

Tuzaklar

• Tarama geç zamanlanırsa arter ve ven birlikte opaklaşabilir; fistül için erken venöz dolum değerlendirmesi güvenilir biçimde yapılamaz.
• AVF saptansa bile eşlik eden damar yaralanmalarını, aktif ekstravazasyonu ve distal arter opasifikasyonunu ayrıca incele; tek bulgu tüm ekstremite damar haritasını tamamlamaz.
• Arter-ven ileti kanalı gösterilemiyorsa, uygun zamanlı arteriyel fazda karşı tarafa göre asimetrik erken venöz opasifikasyon AVF şüphesini destekler.

Kendini dene

1. Travma sonrası BT anjiyografide arteriyel fazda karşı tarafın eş venine göre asimetrik erken dolan komşu ven görülüyor. Bu bulgu en çok hangi tanıyı destekler?

   • Arteriyovenöz fistül
   • Derin ven trombozu
   • Psödoanevrizma
   • Aktif arteriyel kanama
   Cevabı göster

   Arteriyovenöz fistül. Arteriyel fazda karşı tarafın eş venine göre asimetrik erken venöz doluş AVF’yi destekler.

2. Ekstremite travması sonrası BT anjiyografide AVF’yi destekleyen bulgu hangisidir?

   • Arteriyel fazda karşı tarafın eş venine göre asimetrik erken venöz doluş
   • Ven lümeninde dolum defekti
   • Arterden kaynaklanan ve arterle benzer kontrastlanan kese
   • Arter dışına çıkan ve sonraki fazlarda büyüyen kontrast odağı
   Cevabı göster

   Arteriyel fazda karşı tarafın eş venine göre asimetrik erken venöz doluş. Arteriyel fazda karşı taraftaki eş venle karşılaştırıldığında erken doluş AVF’yi destekler; ven lümenindeki dolum defekti trombozu, arterden kaynaklanan kese psödoanevrizmayı, sonraki fazlarda boyutu ve yoğunluğu artan ekstravazasyon ise aktif kanamayı düşündürür.

Kaynaklar

Bu sayfadaki 32 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 8 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.