Recently Developed Undiagnosed Femoral Arteriovenous Fistulas and Cannulation of the Ipsilateral Femoral Vein for Peripheral Cardiopulmonary Bypass in a Patient Undergoing Redo Open Heart Surgery: Perioperative Implications.

Arteriovenous fistula (AVF) results in the shunting of blood from the arterial system into the venous system. The magnitude of the shunt depends on the site, (peripheral vs. central) and the size of the communication(s). The large central shunts are invariably associated with low diastolic blood pressure and congestive heart failure but the smaller ones are challenging to diagnose as they do not have overt clinical features. We describe perioperative implications of recently developed femoral AVFs in a patient undergoing redo aortic surgery (Bentall Procedure) where the ipsilateral femoral vein (femoral vein involved in arteriovenous communications) was used for the establishment of peripheral cardiopulmonary bypass. The patient developed acute limb ischemia and renal failure in the immediate postoperative period and could not be saved. The diagnosis of femoral AVFs was made during the reexploration of the femoral artery for acute limb ischemia.