E3 PreliminaryPreliminaryPEM ✗Case-ControlPeer-reviewedMachine draft
A case of femoral arteriovenous fistula causing high-output cardiac failure, originally misdiagnosed as chronic fatigue syndrome.
Porter, J, Al-Jarrah, Q, Richardson, S · Case reports in vascular medicine · 2014 · DOI
Quick Summary
This case study describes a 34-year-old marathon runner who was initially diagnosed with chronic fatigue syndrome but actually had a rare blood vessel problem called a femoral arteriovenous fistula. This condition, caused by a small injury during a heart catheterization procedure years earlier, created an abnormal connection between an artery and vein in the leg that forced the heart to work much harder than normal. Surgery to repair this fistula completely resolved the patient's fatigue and heart problems, showing that careful medical evaluation is important when fatigue symptoms don't improve with standard treatment.
Why It Matters
This case is important because it highlights a potentially serious but treatable medical condition that can masquerade as ME/CFS. Patients and clinicians should be aware that unexplained fatigue, especially with cardiac symptoms, may occasionally stem from vascular abnormalities rather than primary fatigue disorders. Recognizing this diagnostic possibility could lead to appropriate investigation and cure in affected individuals.
Observed Findings
- A 34-year-old marathon runner presented with progressive fatigue and cardiac symptoms years after femoral arterial catheterization.
- Initial diagnosis was chronic fatigue syndrome despite cardiac symptoms.
- Duplex ultrasound and CT angiography confirmed a significant iatrogenic femoral arteriovenous fistula.
- Elective open surgical repair of the fistula resulted in dramatic and rapid improvement in all symptoms.
Inferred Conclusions
- Femoral arteriovenous fistulas can present with nonspecific symptoms years after the causative catheterization procedure.
- Vascular complications should be considered in the differential diagnosis of unexplained fatigue, particularly when cardiac symptoms are present.
- Surgical repair of hemodynamically significant fistulas can be curative.
Remaining Questions
- How frequently do iatrogenic arteriovenous fistulas present with fatigue-predominant symptoms and get initially misdiagnosed as ME/CFS?
- What clinical or laboratory features best distinguish vascular-induced high-output cardiac failure from primary ME/CFS?
- Should screening protocols for arteriovenous fistulas be incorporated into ME/CFS diagnostic evaluation, and if so, for which patient subgroups?
What This Study Does Not Prove
This single case report does not establish how common vascular fistulas are among patients diagnosed with ME/CFS, nor does it suggest that most ME/CFS cases have vascular causes. It cannot prove causation between the fistula and fatigue in all patients—this was true for one individual. The study also does not address whether screening for arteriovenous fistulas would be cost-effective or beneficial as part of ME/CFS diagnostic workup.
Tags
Symptom:Fatigue
Method Flag:Small Sample
Metadata
- DOI
- 10.1155/2014/510429
- PMID
- 24959370
- Review status
- Machine draft
- Evidence level
- Early hypothesis, preprint, editorial, or weak support
- Last updated
- 8 April 2026