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July 27, 1957


Author Affiliations

Atlanta, Ga.

From the departments of medicine and surgery, Emory University School of Medicine and the Grady Memorial Hospital. Dr. Sellers is a Fellow of the National Foundation for Infantile Paralysis. During this study Dr. Hook was a Whitehead Fellow in Medicine; he is now at the Johns Hopkins Hospital, Baltimore.

JAMA. 1957;164(13):1450-1454. doi:10.1001/jama.1957.02980130026006

• The problem of endarteritis and endocarditis complicating acquired arteriovenous fistula was encountered in two patients. Each patient was hospitalized because of a febrile illness and was found to have a large arteriovenous communication related to prior gunshot wound. The first patient was shown to have endarteritis in a fistula measuring 1 cm. in diameter between the femoral artery and vein, and endocarditis was considered to be present because of aortic insufficiency and peripheral embolic phenomena. His temperature remained elevated despite therapy with penicillin and streptomycin but promptly became normal after surgical removal of the fistula. The second patient, with an extensively calcified aneurysm involving the subclavian vessels, was not conclusively proved to have endarteritis. His temperature also showed no change during penicillin and streptomycin therapy but returned to normal after excision of the fistula. The first patient died one year after surgery, with manifestations of severe aortic insufficiency, and the second made a good recovery. These cases illustrate that in certain instances removal of an arteriovenous fistula may contribute greatly to the control of complicating intravascular infection by antimicrobial drugs.