Traumatic thigh AV fistula leading to aneurysmal changes in aorta and iliac arteries

Abstract

Penetrating traumatic arteriovenous fistulas (AVFs) have the tendency to be clinically silent for many years and could be misdiagnosed as deep venous thrombosis (DVT) on initial presentation. A 52-year-old male underwent a duplex scan to evaluate swelling of the limb, which detected an AVF in the thigh. He was stabbed in the lateral aspect of the thigh 16 years previously. His left leg was larger with a palpable thrill in the thigh. A CT angiogram confirmed the AVF and aneurysmal changes in the common iliac artery (29 mm) and infrarenal aorta (32 mm). A moulding balloon was placed across the AVF by an antegrade puncture of the common femoral artery to control the arterial inflow and outflow. Following disconnection of the AVF, the defect in the side wall of the femoral vein was primarily repaired with Prolene. The defect in the superficial femoral artery was repaired by transection, spatulation and end-to-end anastomosis of the arteries. A Duplex scan performed six months postoperatively showed that the aorta (29 mm) and the common iliac artery (27 mm) had regressed. The authors suggest that, when faced with an AVF with a huge calibre mismatch between the arterial segment proximal and distal to the fistulous tract in a young patient, a hybrid approach should be considered for control and surgical disconnection of the fistula.