Connection Between a Long-standing Traumatic Arteriovenous Fistula and Development of Aneurysmal Disease

Staged endovascular repair of an abdominal aortic aneurysm adjacent to a chronic high-flow iliocaval traumatic arteriovenous fistula

Large-vessel chronic traumatic arteriovenous fistulas are a rare complication after trauma. Delayed presentation can consist of one or more features of high-output cardiac failure, pulsatile abdominal mass, bruit, limb ischemia, and venous congestion. We describe a patient with a complex iliocaval fistula secondary to a remote gunshot wound associated with a large 8.5-cm aortic aneurysm. Informed consent of the patient was obtained for publication of the case.

Case report: Hybrid endovascular and open surgical approach to a chronic, traumatic arteriovenous fistula

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Chronic traumatic AVF leads to significant morbidity when allowed to progress.

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Traumatic AVF may be approached with endovascaular, open, and hybrid techniques.

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We describe a traumatic AVF which was left to progress for over 30 years.

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Our staged, hybrid approach decreased venous hypertension and bleeding during surgery.

Endovascular repair of a proximal ilio-iliac arterio-venous fistula and distal pseudoaneurysm of the hypogastric artery 23 years after penetrating trauma

We report the treatment of a proximal ilio-iliac arterio-venous fistula and distal omolateral hypogastric artery pseudoaneurysm 23 years after incurring a gunshot wound in a 43-year old man presenting with lower back pain. No cardiac, pulmonary or omolateral lower limb alteration was observed. Endovascular exclusion of the arterio-venous fistula and pseudoaneurysm was performed, which included pseudoaneurysm embolization. Three procedure-related complications were registered. The follow-up at 12 months revealed stent grafts patency, pseudoaneurysm and fistula exclusion.

Incremental role of three-dimensional over two-dimensional ultrasound in the assessment of traumatic peripheral arteriovenous fistula

We present a patient with an accidental self-inflicted stab wound to his right thigh in whom three-dimensional (3D) ultrasound was able to find two communications between the right femoral artery and the femoral vein, in contrast to two-dimensional (2D) peripheral ultrasound which could find only one communication between them, thereby showing an incremental value of 3D over 2D ultrasound.

Staged approach for surgical management of external iliac vein aneurysm associated with traumatic femoral arteriovenous fistula

Aneurysms of the iliac vein are rare. They can occur in association with arteriovenous fistulae located elsewhere. Here, we present a 30-year-old man who developed a large left external iliac vein aneurysm in association with a chronic traumatic arteriovenous fistula in the left thigh. Less than 25 cases of iliac vein aneurysms have been reported in the last 40 years. The presentation and treatment of this condition has been heterogeneous. We suggest that adequate surgical treatment can be offered in a staged approach: aneurysm resection with reconstruction should be done first, followed by closure of the arteriovenous fistula 6 months later.

Diagnosis of Clinically Unsuspected Posttraumatic Arteriovenous Fistulas of the Pelvis Using CT Angiography

OBJECTIVE

Traumatic arteriovenous (AV) fistulas present with a variety of clinical manifestations and may prove difficult to detect. The clinical sequelae of undiagnosed AV fistulas are significant and include dilatation of the vessels, venolymphatic trophic complications, and heart failure. In this article, we report two rare cases involving long-standing noniatrogenic AV fistulas of the pelvis that were detected using 64-MDCT angiography (CTA) 14 and 20 years after a trauma.

CONCLUSION

With the increased use of CTA for the diagnosis and follow-up of trauma patients, we might better detect AV fistula formation and thereby prevent the onset of sequelae normally associated with chronically undiagnosed AV fistulas.

Endovascular Repair of a Traumatic Arteriovenous Fistula 34 Years After the Injury: Report of a Case

Penetrating extremity injuries can result in the development of arteriovenous fistulas (AVFs), whereby normal blood flow through the capillary bed is bypassed. Late complications of untreated AVFs include proximal arterial dilatation, venous congestion, congestive heart failure, and distal ischemia. We report the case of a 57-year-old man who was referred to us for treatment of a traumatic AVF with multiple sequelae, 34 years after he sustained a shrapnel injury to his right lower leg. We performed successful endovascular repair of this AVF with the patient under spinal anesthesia. Computed tomographic angiography (CTA) done 1 month and 6 months later confirmed AVF exclusion. Patients may present with sequelae of traumatic AVFs many years after their initial injury. Endovascular repair of AVFs offers several advantages over conventional repair and can be performed successfully even in the presence of complex anatomic abnormalities.