0:00

Now the next patient is a 54-year-old man

0:03

with palpable white joint, uh, abnormality, history

0:07

of IV drug use.

0:09

So here we have yet another, uh, flow pattern.

0:14

So if we look at the left side here, first of all,

0:18

you notice that there is a lot of tissue brewery

0:23

and there is very, very turbulent flow within that vessel.

0:27

This is not normal for an artery.

0:29

This is not normal for a pain, okay?

0:31

And this was a continuous voice. So what are we thinking?

0:36

So we then we look at the vessels around it.

0:38

So the right side was normal. I'm showing it for comparison.

0:42

You have turbulent flow in the left iliac vein,

0:47

and you have in the left iliac artery,

0:49

you have a very abnormal flow for an artery, a,

0:53

a peripheral artery that is continuous

0:54

forward for diastolic.

0:55

Okay, so what are we thinking?

0:56

We are thinking the patient has a

1:00

fistula right there, an arter venous fistula.

1:04

Okay, but remember he was an IV drug user.

1:07

So again, now we look

1:09

and there's a fistula as well as a pseudo aneurysm.

1:11

But again, this is more of a admixture,

1:14

ofer and venous flow.

1:16

And when we look at the, the CT here, there is

1:21

contrast in the artery

1:23

and the vein at the same time, again, confirming

1:26

that this is a AV fistula.

1:29

Okay, so what are you going to see in AV fistula?

1:31

You, you're gonna see in mosaic color pattern, you have,

1:34

you're gonna have a color bluey, which is the equivalent

1:37

of the palpable flail.

1:39

You'll have a low resistant turbulent flow.

1:42

And so in this case, I would,

1:44

I was showing you flow in the artery and the vein as well,

1:48

and the right side was normal.

1:51

Okay? So what happens here is that, again,

1:53

usually I atrogenic, uh, you have a track

1:57

between the artery

1:58

and the adjacent vein, which, which creates a communication

2:01

between the artery and vein.

2:02

So the vast majority are atrogenic.

2:05

Uh, you occasionally, as the first patient I showed you,

2:08

could be from, uh, IV drug use.

2:11

And the treatment is more complicated than than

2:13

pseudo simple pseudo.

2:14

And usually, uh, if it's a big AV fistula,

2:18

these patients will need surgical repair.