Posttraumatic Arteriovenous Fistula Research Articles

High-Output Heart Failure Secondary to Post-Traumatic Arteriovenous Fistula

Introduction: Arteriovenous fistulas are abnormal connections between the arterial and venous systems that bypass normal anatomical capillary beds. Any device, implement, or projectile that passes through an artery and vein has the potential to lead to one, thereby preventing normal blood flow through the capillary bed. Late complications of untreated arteriovenous fistulas include proximal arterial dilation, venous congestion, congestive heart failure, and distal ischemia. Objective: Describe the clinical manifestations, diagnostic, therapeutic, prognostic complexities and complications present in post-traumatic arteriovenous fistula and its association with heart failure. Material and methods: Retrospective study presentation of a clinical case. Results: The case of a 55-year-old female patient is presented, with a 2-year history of ischemic heart disease and a gunshot wound 20 years ago. Who was admitted for bypass and coronary angiography + cardiac angiography in whom no etiology of his dilated ischemic heart disease was found until Doppler ultrasound and tomography angiography was performed due to recurrence of pain in the lower limbs and changes in skin color, which revealed presence of arteriovenous fistula. The same one that was resolved with distal ligation of the popliteal vein + exclusion of aneurysm. Conclusions: Risk factors for the development of this pathology are difficult to establish. Therefore, the shotgun trauma to the left leg 20 years ago, in addition to her obesity and female sex, led to the formation of an arteriovenous fistula that would gradually produce high-grade heart failure. Endovascular AVF repair is a treatment alternative for those patients considered high risk from anesthesia, those who have a hostile groin due to excessive scar tissue, or who cannot tolerate the consequences of bleeding that can occur with surgical control. of the FAV.

Diagnosis of post-traumatic arteriovenous fistula on the back of the tongue: the importance of ultrasonography

Arteriovenous fistulas (AVF) are vascular anomalies that can occur after trauma in different parts of the body, including the oral cavity, these abnormalities can trigger several consequences for the affected individual. Such abnormality can be classified as acquired, usually after some trauma or hemodialysis, and congenital. Its diagnosis, in turn, is essential for the management of the patient, avoiding clinical complications. In the oral cavity, although rare, it can affect, especially, the dorsum of the tongue. Ultrasonography is an imaging technique that can be useful in diagnosing AVF in the tongue. This technique allows visualizing vascular structures in real time, assessing blood flow and identifying anomalies such as AVFs. The present study aims to report a case of a 39-year-old female patient who presented a post-traumatic AVF caused by a foreign object in the region of the right dorsum of the tongue. During the professional evaluation, it was possible to use color Doppler ultrasonography to elucidate the presence of venous and arterial flow in the abnormal region, corroborating the clinical findings and being essential to close the diagnosis, denoting the important role of this imaging exam.

Posttraumatic arteriovenous fistula of the lower extremity and the pathological characteristic—case series and literature review

Abstract The clinical presentation, treatment history, and outcomes of two patients with posttraumatic arteriovenous fistula (PTAVF) were analyzed and compared with the pathological tissues of patients with hemodialysis arteriovenous fistula (HAVF). A search of the biomedical literature database (PubMed), using the keywords “ lower extremity” and “PTAVF,” was conducted to obtain results and review the data. Postoperative histological analysis of patients with PTAVF showed differences from that of HAVF. The literature screening and analysis revealed that PTAVF is a chronic progressive process, with 70% of patients diagnosed after 3 months. The choice of treatment revealed that 20% of patients had severe complications and all were treated endovascularly. Due to the abnormal fistula of PTAVF and its specific histopathological features, the disease is not self-limiting. It is unwise to wait for PTAVF to cause “failure.” We recommend early and timely cure of this disease by surgery to avoid serious complications.

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

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.

Traumatic Superficial Femoral Arteriovenous Fistula with Pulsatile Mass and Leg Pain 60 Years after Stabbing Injury.

Post-traumatic arteriovenous fistula (AVF) is a vascular injury complication and can present with vessel dilation, forming pulsatile varices, venous hypertension, distal ischemia, and congestive heart failure. We present a case of only pulsatile mass and leg pain caused by a 60-year-old post-traumatic AVF. Computed tomography angiography showed an AVF between the superficial femoral artery and superficial femoral vein. Surgical repair with AVF ligation was successfully performed. Traumatic AVF caused vascular and heart failure in the future; therefore, post-traumatic AVF is better eliminated as soon as possible.

Traumatic arterial injuries in upper and lower limbs: what every radiologist should know.

Traumatic arterial injuries of the extremities are a rare but potentially fatal event. Computed tomography (CT) angiography of the extremities has become the technique of choice and can provide rapid accurate detection and characterization of vascular lesions. Vascular injuries can be classified in active hemorrhage, vasospasm, occlusion, post-traumatic arteriovenous fistula, pseudoaneurysm, and patterns of intimal injuries. The learning objectives of this pictorial essay are to review the normal arterial anatomy of the upper and lower limbs, describe the technique of CT angiography in vascular trauma of the extremities, describe and illustrate the CT-angiography findings of traumatic arterial injuries, and know the potential pitfalls when interpreting a CT-angiography of the extremities.

Management of Posttraumatic Arterioveinous Fistulas of the Limbs in a Sub-Saharan Country

Introduction: Post-traumatic arteriovenous fistulas of the limbs most often occur after trauma but can be iatrogenic since the advent of interventional methods. Materials and methods: This is a retrospective study which took place at the thoracic and cardiovascular surgery department / FANN in Dakar, Senegal over a period from 2006 to 2021. Results: Seven patient files identified were been collected. All were male with an average age of 21 years. The mechanism and the topography of the predominant traumatism being a stabbing attack on the thigh and the average consultation time is 71 days. The limb vessel ultrasound and CT angiography can confirm the diagnosis. All patients underwent open surgery. The outcome was favorable in all patients. Conclusion: Post-traumatic arteriovenous fistulas of the limbs are rare, the diagnosis is clinical and open surgery retains its place in the management.

Chronic Leg Swelling And Venous Ulcer As A Late Complication Of Post-Traumatic Arteriovenous Fistula: A Case Report

Chronic post-traumatic arteriovenous fistula is a late complication of vascular injury and presents symptoms of venous hypertension and ulceration, as well as congestive heart failure in advanced stages. We present rare case of chronic leg swelling and ulceration in an adult caused by post-traumatic arteriovenous fistula.

Delayed presentation of a post-traumatic lower extremity arteriovenous fistula.

Delayed presentation of a post-traumatic lower extremity arteriovenous fistula.

Diagnosis and treatment of posttraumatic arteriovenous fistula in the lower leg - a case report.

External injuries are one of the common reasons for reporting to hospital emergency departments. Peripheral vascular injuries occur in up to about 25% of upper and lower extremity injury cases. Arteriovenous fistula is a type of arterial injury. Doppler ultrasound is currently the primary diagnostic method for vascular injuries as it allows for the implementation of appropriately targeted treatment, indicating the potential need for extended diagnosis or patient qualification for endovascular or classical surgery. Endovascular procedures are currently an acknowledged treatment method in peripheral vascular injuries. We present a case of endovascular treatment in a patient with posttraumatic arteriovenous fistula in the lower leg. Patient qualification and treatment efficacy assessment were performed using Doppler ultrasound.

Varicocele Due to Post-traumatic Arteriovenous Fistula

Varicocele consists of abnormally dilated and tortuous veins within the pampiniform plexus, usually in the left scrotum. We reported a rare case of right varicocele due to post-traumatic arteriovenous fistula successfully treated by percutaneous embolization.

Imaging of Vascular Injuries of the Extremities.

Multidetector computed tomography angiography (MDCTA) of the upper and lower extremities is the standard of care in the assessment of trauma patients with vascular trauma of the upper and lower extremities. A MDCTA of the extremities is typically integrated into multiphasic whole-body computed tomography trauma protocols in patients with suspected vascular injury. MDCTA has replaced catheter-directed digital subtraction angiography (DSA) as the modality of choice for the initial detection and characterization of vascular injuries because it is readily available, noninvasive, and faster than DSA. Understanding the imaging findings and pitfalls of upper and lower extremity MDCTA is essential in the diagnosis of vascular injuries such as active hemorrhage, vasospasm and stenosis, hematoma, occlusion and thrombosis, posttraumatic arteriovenous fistula, pseudoaneurysm, and patterns of intimal injury including dissection. We discuss the diagnosis and characterization of vascular injuries of the upper and lower extremities using MDCTA including derived multiplanar reconstructions, maximum intensity projection, and three-dimensional volume rendering techniques.

Chronic leg ulcer as a complication of post-traumatic arteriovenous fistula: colour doppler evaluation

Arteriovenous fistula (AVF) can be either be iatrogenic, traumatic or congenital. Most femoral AVFs commonly developed secondary to penetrating injuries. This is a case of post traumatic femoral AVF in a 40 year old man who presented with chronic leg ulcer, is presented to illustrate the inherent danger in the delayed diagnosis and treatment of AVF and role of ultrasound in diagnosis. Review of the existing literature outlining the pathogenesis, clinical features and radiological therapeutic considerations as they relate to arteriovenous fistula.

A case report of rare coexistence of posttraumatic complex arteriovenous fistula and venous pseudoaneurysm of lower limb: Concomitantly arterial and venous endovascular stent graft placement

Arteriovenous fistulas of the lower limb are frequently resulted from trauma and treated with endovascular techniques. However, venous pseudoaneurysms are extremely rare entities existing together with fistulas, and most preferred therapy for them is still surgery. We present a 31-year- a male patient who has a complex arteriovenous fistula between superficial femoral artery and vein and pseudoaneurysm in the distal segment of superficial femoral vein with a history of firearm injury. The patient was treated with both arterial and venous endovascular stent-grafting. Arteriovenous fistulas of the lower limb are frequently resulted from trauma and treated with endovascular techniques. However, venous pseudoaneurysms are extremely rare entities existing together with fistulas, and most preferred therapy for them is still surgery. We present a 31-year- a male patient who has a complex arteriovenous fistula between superficial femoral artery and vein and pseudoaneurysm in the distal segment of superficial femoral vein with a history of firearm injury. The patient was treated with both arterial and venous endovascular stent-grafting.

Treatment of posttraumatic arterio-venous fistula between right common iliac artery and inferior vena cava

Treatment of posttraumatic arterio-venous fistula between right common iliac artery and inferior vena cava

Missed Diagnosis of an Arteriovenous Fistula by Penile Color Doppler Ultrasonography in a 20-year-old Male

High-flow priapism secondary to posttraumatic arteriovenous fistula (AVF) formation is a condition that can be easily diagnosed via penile color Doppler ultrasonography. In order to make the diagnosis, however, adequate coverage of the shaft and perineum is required when performing the scan. This case highlights failure to properly cover these areas, resulting in missed diagnosis of penile AVF.

A Rare Complication of Blunt Traumatic Injury: Posttraumatic Intrasplenic Arteriovenous Fistula and Treatment by Superselective Coil Embolization

Posttraumatic intrasplenic arteriovenous fistula is a very rare complication of blunt traumatic injury. Computed tomography angiography is a useful and noninvasive technique to follow up nonsurgically managed patients with posttraumatic splenic injury and has a vital role detecting delayed complications such as arteriovenous fistula. Endovascular treatment of a vascular complication prevents risk of surgery and splenectomy complications. We present a case of posttraumatic arteriovenous fistula in 39-year-old male which was diagnosed by computed tomography angiography and successfully treated by transcatheter coil embolization.

Our vascular surgical experience in arteriovenous fistula induced by gunshot injury

Background: In this study, we aim to present our surgical experience in seven patients who were operated for arteriovenous fistula (AVF) induced by gunshot injury. Methods: Seven patients, who developed AVF as a result of gunshot injury and were operated at our clinic between November 2011 and August 2012, were included in this study. The patients were retrospectively evaluated in terms of injured body area, the timing of surgery, and surgical procedures performed. Results: Arteriovenous fistula was in the lower extremity in six patients (85.71%), and in the upper extremity in one patient (14.29%). In lower extremity, AVF was present between popliteal artery and popliteal vein in four patients, and between femoral artery and femoral vein in two patients. In upper extremity, AVF was located between brachial artery and cephalic vein. We performed primary repair of the artery and vein in four patients, graft interposition to artery and primary repair of vein in two patients, and graft interposition to artery and vein in one patient. Dacron graft was used for all patients. Conclusion: In penetrating injuries near major vascular structures, anamnesis and physical examinations should be conducted carefully, and auscultation should not be neglected. Indications for surgical treatment are present in all AVF patients. The requirement and timing of surgical treatment depend on the location and dimension, and the local and systemic effects of AVF. In large and post-traumatic AVFs, surgical treatment should be performed as early as possible.

Posttraumatic arteriovenous fistula of the distal posterior tibial artery as cause of delayed wound healing in an unrecognized arterial injury.

Background Cases of posttraumatic arteriovenous (AV) fistula of the distal lower limb are rarely reported. Time from trauma to diagnosis varies from hours to years. Case Description This case report of a 51-year-old male patient shows very impressively the extensive consequences of an unrecognized traumatic AV fistula. The fistula developed here after a car accident led to a massive healing delay in a pilon fracture of the tibia and a wound, resulting in almost 1 year immobilization, 20 operations, and extensive pain drug therapy. After surgical revision of the fistula, bone and wound healing improved quickly. Conclusions The possibility of an AV fistula should be considered in case of persistent swelling after high-energy trauma of an extremity. The therapy of choice is surgery and the long-term result of successful fistula ligature is excellent.

Management of chronic traumatic arteriovenous fistula of the lower extremities.

Vascular injuries secondary to blunt or penetrating trauma are a significant cause of morbidity and mortality, especially in war-afflicted areas. Due to the violent situations of Pakistan and the unavailability of vascular services in remote areas, we are witnessing an increase in the number of delayed/chronic post-traumatic arteriovenous fistulas (AVFs) of the extremities in our institution. The purpose of this study is to share our experience of post-traumatic AVF and the incidence, presentation, and outcomes of these patients. A 10-year retrospective study between January 2002 and May 2012 was conducted. We studied 30 patients with post-traumatic AVF of the lower limbs. All 30 cases were due to penetrating injuries, either by gun shots or bomb blasts. All of the patients were treated surgically, except for one patient who was treated with a covered stent. The interval between surgery and presentation ranged from 6months to 20years. All patients had complete obliteration of the fistulous tract and there was no recurrence and no post-operative mortality. Long-standing traumatic AVF is becoming common in Pakistan. Surgery remains the standard treatment.