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.
Highlights
Vascular injuries account for approximately 2–4% of trauma admissions with only 2.5% of these being traumatic arteriovenous fistulas (AVFs)
This injury is commonly missed with up to 70% of patients diagnosed in a delayed fashion
Clinicians must maintain a high index of suspicion to correctly diagnose and manage this injury in a timely fashion in order to avoid potentially nonreversible morbidity and mortality
Summary
Vascular injuries account for approximately 2–4% of trauma admissions with only 2.5% of these being traumatic arteriovenous fistulas (AVF). This injury is commonly missed with up to 70% of patients diagnosed in a delayed fashion. Up to 50% of clinical exams have been reported as misleading which explains the difficulty in making the correct diagnosis and the large number of cases being diagnosed in a delayed fashion [2,3]. The pathophysiology of a traumatic arteriovenous fistula incorporates an initial simultaneous injury to an artery and adjacent vein, which subsequently leads to an abnormal communication between the two vessels [3]. This work has been reported in line with the SCARE criteria [5]
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