Traumatic femoral arteriovenous fistula following gunshot injury: Case report and review of literature

Abstract

IntroductionVascular injuries account for approximately 2–4% of trauma admissions with only 2.5% of these being traumatic arteriovenous fistulas (AVFs). We offer a case report of a traumatic AVF and review of the literature. Presentation of caseA 40-year-old male presented following 4 gunshot wounds, 2 in the forearm and 2 in the left upper thigh. The patient had decreased range of motion and paresthesia of the left lower extremity with palpable pulses and adequate capillary refill in all extremities. A CT angiogram demonstrated a left traumatic AVF involving the left deep femoral artery and left common femoral vein with an adjacent bullet fragment. The patient was taken to the operating room and underwent an exploration of the left groin, repair of the traumatic AVF, and removal of bullet fragment. The venous aspect had a grade IV injury and was ligated. The arterial defect was debrided to healthy tissue and repaired primarily. The patient recovered from his injuries with adequate ambulation and resolution of lower extremity edema. He was discharged home on postoperative day 4 on aspirin and a compression stocking. DiscussionTraumatic AVFs are rare, with up to 70% diagnosed in a delayed fashion. Clinicians must maintain a high index of suspicion to correctly diagnose and manage this injury to avoid potential morbidity and mortality. ConclusionDespite literature accounts of surgeons’ experience, this pathology is lacking level one evidence-based standardized surgical management algorithms. Controversy exists regarding venous repair methods.