Case Report: Endovascular Repair of An Internal Iliac Arteriovenous Fistula Secondary to Penetrating Trauma 20 Years Prior to Current Presentation

Abstract

Acquired arteriovenous fistula (AVF) subsequent to penetrating trauma is a known vascular entity with well-documented pathophysiology. Acquired AVF located in the iliac arteries are rare event. We present a patient with a symptomatic high-output traumatic AVF between the left internal iliac artery and external iliac vein (Fig 1). The AVF occurred secondary to an abdominal gunshot wound sustained by the patient 20 years before presentation. The patient presented with classic symptomatology, including leg swelling and congestive heart failure. The patient underwent endovascular repair with covered stenting of the left internal iliac artery, which excluded the AVF and maintained arterial patency (Fig 2). Exclusion of the AVF was confirmed at the time of surgery and at 1 month and 6 months. This case report describes the successful endovascular repair of a traumatic internal iliac artery AVF and reviews the recent literature regarding proximal AVF. Endovascular repair of acquired proximal (aortic/iliac) AVF has become the treatment of choice given the high rates of success and minimal morbidity. Open surgery for proximal AVF is reserved for cases in which endovascular intervention is not feasible.Fig 2Computed tomography reconstruction of a traumatic arteriovenous fistula (AVF) after endovascular repair.View Large Image Figure ViewerDownload Hi-res image Download (PPT)