Traumatic arteriovenous fistula: a 25-year delay in presentation

Abstract

A 64-year-old lady presented with a 6-month history of worsening unilateral leg swelling, with an audible bruit of the popliteal artery. Arterial duplex ultrasound confirmed the presence of an arteriovenous fistula (AVF) between the posterior tibial artery and vein. Upon thorough history, it was discovered that the patient had sustained a stab wound to this region some 25 years prior. The fistula was successfully managed endovascularly by means of a covered stent. This case highlights an unusual delayed presentation of an AVF and demonstrates the effectiveness of endovascular treatment of this condition.

Successful Endovascular Treatment of a Traumatic Cervical Arteriovenous Fistula After a Carotid Paraganglioma Resection: A Case Report

“…Although CAVFs are associated with different types of traumas like central line insertions, gunshot wounds, and neck surgical procedures, the vascular injury seems to be the only constant in all acquired cases, independent of the trauma mechanism, even if it is blunt trauma [ 1 , 2 ]. The symptoms caused by AVFs are mainly from retrograde venous congestion (headache, swelling, pulsatile mass, or even glaucoma) or from decreased distal arterial supply (syncope) [ 5 , 6 ]. In our case, the CAVF symptoms were predominantly secondary to increased venous pressure since our patient presented with a prominent and painful facial swelling in the dilated facial vein territory and a pulsatile mass sensation.…”

Delayed presentation of upper extremity arteriovenous fistula after total shoulder replacement

“…It has been estimated that vascular injuries occur in only 0.005% of all elective orthopedic surgery cases [18]. In the literature, there have been described cases of delayed presentation of arterial injury symptoms and axillary artery injury following a TSA, but there has not been a reported case in which the diagnosis of vascular injury occurred more than one month following a TSA [1,2,7,8,9,16,19]. All of these cases emphasize the importance of early detection and treatment of the injury.…”

“…Arteriovenous fistulas are abnormal connections in between an artery and a vein that are classified as either congenital or acquired [4,16,17]. Acquired AVFs can result from blunt trauma or puncture wounds and are further classified as iatrogenic fistulas when they occur as a result of an intervention such as an arterial or venous access procedure [4,16,17]. Many acquired AVFs are asymptomatic and spontaneously resolve, but those that are determined to be clinically significant, require surgical intervention [8,16].…”

“… 4 , 16 , 17 Acquired AVFs can result from blunt trauma or puncture wounds and are further classified as iatrogenic fistulas when they occur as a result of an intervention such as an arterial or venous access procedure. 4 , 16 , 17 Many acquired AVFs are asymptomatic and spontaneously resolve, but those that are determined to be clinically significant require surgical intervention. 8 , 16 According to Yagubyan et al, approximately 10% of acquired axillary artery injuries are treated conservatively as the axillary artery has five branches to support the upper extremity and ischemia rarely results.…”

“… 4 , 16 , 17 Many acquired AVFs are asymptomatic and spontaneously resolve, but those that are determined to be clinically significant require surgical intervention. 8 , 16 According to Yagubyan et al, approximately 10% of acquired axillary artery injuries are treated conservatively as the axillary artery has five branches to support the upper extremity and ischemia rarely results. 20 It is of note, although, that surgical intervention is indicated when there is detection of a laceration or occlusion of an artery.…”