7113 - Arteriovenous fistula, traumatic

Alternate Name:Traumatic A-V aneurysm

DBQ: Link to Index of DBQ/Exams by Disability for DC 7113

Acronym: AVF

Definition

A traumatic arteriovenous fistula condition is an acquired abnormal communication between an artery and a vein in which the blood flows directly into a nearby vein or is carried into the vein by a connecting sac.

Etiology

The cause could be a penetrating wound from a bullet or knife, or a post-operative complication of an arterial catheterization.

Signs & Symptoms

The clinical picture is dependent on the size and location of the fistula. A pulsating mass can be felt along with a thrill and a bruit during systole and diastole over the fistula. When fistulas have been present for a long time, the signs and symptoms of chronic venous insufficiency (due to high venous pressure) become obvious. Large varicose veins, peripheral edema and stasis skin pigmentation are presented. Increased cardiac output, enlarged heart (cardiomegaly), and a high output heart failure occur in large arteriovenous fistulas.

Tests

Physical examination will reveal fistulas. When a large arteriovenous fistula is compressed, it will cause Branham's sign. The size and shape of the fistula can be seen with arteriography.

Treatment

Surgery is used in acquired arteriovenous fistula either to excise it, or to use embolization where fat, muscle or a gelatin sponge is used to obliterate it.

Residuals

The artery and vein, in some circumstances, may need grafting to reestablish continuity.

Special Considerations

  • May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

Notes

  • The rating criteria for cardiovascular conditions underwent full-scale revision effective on November 14, 2021 and January 12, 1999.  A regulatory change was effective August 13, 1998, updated criteria for cold injury residuals under 38 CFR 4.104, DC 7122.  The changes are not considered liberalizing and should not be used as the basis for reduction unless the disability has actually improved.