Case Report of Patient with Posttraumatic Arteriovenous Fistula of Femoral Vessels in the Lower Third of Thigh: Peculiarities of Pathogenesis and Difficulties of Management

Abstract

INTRODUCTION: Pathological communications between the arterial and venous systems have been in the center of attention of surgeons since XVIII century. Despite the achievements of the modern medicine, the diagnosis and treatment of arteriovenous fistulas (AVF) is still quite a difficult problem. The most common location of AVF is the lower limbs ― 17% of cases. Because of the peculiarities of structure and clinical manifestations of posttraumatic AVF, they are diagnosed several years after the injury. Diagnostic errors reach 30%, and unsatisfactory results of surgical treatment are observed in 30% to 70% of cases. The article describes a clinical case of a patient with a rare posttraumatic AVF in the lower third of thigh identified 2 years after fracture of a lower limb. Initially, the patient was delivered to hospital for surgical treatment for varicose vein disease of the left lower limb (C5 in CEAP classification). In the follow-up examination at the department of vascular surgery, a posttraumatic AVF of femoral vessels in the lower third of thigh was found with alterations of central hemodynamics (according to the heart ultrasound data). An attempt of open disconnection of the AVF was undertaken, however, morphological alterations of the walls of femoral vessels caused by a long-existing fistula did not permit this to be done. In result, for effective disconnection of AVF two stages of endovascular treatment were required.
 CONCLUSION: This medical case is given by the authors because of the rarity of pathology, atypical clinical manifestations and diagnostic difficulties. This case is also interesting from the point of view of the fact that effective disconnection of AVF required several stages of endovascular treatment.