Traumatic Arteriovenous Fistula Research Articles

Endovascular Treatment of a Forty-Year-Old Post-Traumatic Knee Arteriovenous Fistula.

Arteriovenous fistulas (AVFs) of the lower extremity are uncommon. The main causes are traumatic or iatrogenic, with 15% of traumatic AVFs occurring in the popliteal vessels. Herein, we present a 60-year-old female with a traumatic AVF caused after a car accident 40years ago. The patient presented with right leg venous claudication and symptoms of congestive heart failure. Duplex ultrasound of lower limb vessels revealed an AVF at the distal part of the tibiofibular trunk. The patient was successfully managed with an endovascular approach using a coil-assisted covered endovascular repair technique of the tibiofibular bifurcation (CERTIFIB) with excellent results and distal vessels patency. At 3months follow-up, patient presented with an impressive regression of 3cm of the lower extremity oedema and improvement of both claudication and heart failure.

Scalp Arteriovenous Fistula Following Hair Transplantation: A Rare Case Report

A traumatic scalp Arteriovenous Fistula (AVF) caused by hair transplantation are extremely uncommon. It is a communication between branches of the arteries and draining veins in the scalp’s subcutaneous tissue, Because of the very low incidence of this complication, available literature is limited to single case reports. The clinical manifestations of scalp AFV may range from a pulsatile mass to epilepsy

Management of Traumatic Arteriovenous Fistula as a Complication of Minimally Invasive Endoscopic Maxillofacial Surgery: A Case Report

A traumatic arteriovenous fistula (AVF) is a type of acquired vascular malformation, caused by blunt or penetrating trauma. Traumatic AVFs result in a pathologic connection between arterial and venous vasculature, bypassing the corresponding capillaries. When an intra-operative insult to vasculature within a surgical site is implicated in the subsequent formation of a traumatic AVF, the suspected etiology is iatrogenic. Although the most common etiology of traumatic AVFs of the entire body is iatrogenic trauma, intraoperative vascular insults (ie, ligation and cauterization) are routinely delivered within maxillofacial surgical sites, without formation of an acquired vascular malformation. A traumatic AVF in the pre-auricular region is exceedingly rare and has infrequently been described as a complication following minimally invasive temporomandibular joint (TMJ) surgery, managed with endovascular surgery. We describe a rare case of bilateral TMJ arthroscopies complicated by the formation of a pulsatile, traumatic AVF between the right superficial temporal artery and right retromandibular vein, treated with minimally invasive endovascular embolization by the interventional radiology team. This case report highlights the diagnosis of a traumatic AVF in the pre-auricular region and multi-specialty management of an early complication of minimally invasive maxillofacial surgery.

Renal Arteriovenous (AV) Fistula after High-Grade Blunt Renal Trauma Caused by Traffic Accidents.

To report a series of three patients with traumatic renal AV fistulas after blunt renal laceration. We retrospectively analyzed the renal trauma cases treated in the Department of Urology of Salzburg University Clinic during a time period of 10 years concerning traumatic AV fistula formation and other clinical parameters. In total, 3 cases of traumatic AV fistula formation were identified in 106 blunt renal trauma patients (2.8%), with a mean age of 39 (17-56) years. All renal traumas were classified as American Association for the Surgery of Trauma (AAST) grade IV. Two patients were primarily treated with ureteral stent; one was managed conservatively. All AV fistulas were diagnosed after a mean time of 7 (1-13) days. Two patients were symptomatic with gross hematuria, and the mean time between trauma and onset of symptoms was 11 (9-13) days. All cases were managed via coil embolization after a mean of 10 (8-13) days. Two patients received a second intervention after a mean of 18 (11-25) days. The mean AV fistula size was 18.7 (12-24) mm. Mean hemoglobin loss was 3.6 g/dL. One patient received one erythrocyte concentrate. Discharge was after a mean time of 13.3 (7-12) days, with the mean time of intensive care treatment being 2.3 (1-3) days. Traumatic renal AV fistula is a rare but severe complication associated with higher-grade renal trauma. It can become evident through hematuria or blood loss several days after the initial trauma. The availability of coil embolization in a trauma center can help kidney preservation management.

Traumatic middle meningeal arteriovenous fistula presenting with long delayed-onset facial nerve palsy without temporal bone fracture: illustrative case.

Traumatic facial nerve palsy (FNP) without temporal bone fracture (TBF) has a delayed onset in some cases; however, long delayed-onset FNP in this setting has not been reported. The middle meningeal vein (MMV) is one of the venous drainage routes from the facial nerve. Herein, the authors describe a rare case of traumatic middle meningeal arteriovenous fistula (MMAVF) presenting with the long delayed-onset FNP without TBF. A 42-year-old man with pulsatile tinnitus and left FNP was admitted to our hospital 4 weeks after head trauma without TBF. Cerebral angiography revealed an MMAVF between the middle meningeal artery and the MMV on the left side. Seven days after admission, the FNP showed slight improvement, and preoperative angiography revealed decreased shunt flow of the MMAVF. Transarterial coil embolization was successfully performed. Postoperative angiography showed no residual fistula. Two weeks after the procedure, there was complete resolution of the FNP. This clinical course was correlated with the angiographic findings, suggesting that the long delayed-onset FNP was caused by the traumatic MMAVF without TBF. In patients presenting with long delayed-onset FNP after head trauma without TBF, the vascular lesion must be evaluated to exclude MMAVF.

Therapy for Necrotic Fingertip Ischemia Secondary to Traumatic Arteriovenous Fistula

Background: This is the first report on an accidental arteriovenous fistula of the upper limb. We discuss in this publication the clinical presentation, diagnostic process and treatment options of arteriovenous fistula (AVF) that can be conservative and interventional. Case presentation: We are reporting a case of a 89-year old white man with a necrotic fingertip ischemia secondary to a traumatic AVF. A Doppler sonography showed an AVF between the metacarpal bones of the digits 1 and 2 and confirmed a hand and forearm vein dilation. A fistula ligation would be indicated as first-line therapy, which was rejected by the elderly multimorbid patient. Owning to risk of potential wound healing problems, lifetime medical management such as manicure of the right index is recommended. In case of injury, compression therapy should be performed. The follow up was without complication. Conclusion: A fistula ligation is the therapy of choice in a patient with an arteriovenous fistula of the upper limb.

Hybrid Management for Traumatic Iliac Arteriovenous Fistula

Traumatic arteriovenous fistulas are usually the evolution of non-treated contiguous arterial and venous injuries inflicted by firearm projectiles. As time passes, these fistulas can lead to systemic and local repercussions. Endovas-cular management offers great benefit in reducing the risks of open surgery for correcting these fistulas, but unfor-tunately some endovascular resources are not always available.In this situation, a hybrid management offering an endovascular strategy to control bleeding, while allowing an open disconnection of the affected artery and vein, may be useful in dealing with these complex injuries. In this article, the authors report a case of traumatic arteriovenous fistula between the common iliac vessels, managed with a hybrid strategy and make comments about practical issues regarding planning the open part of the procedure and anticipating possible complications when treating such injuries.

Abstract Number ‐ 79: Flow Diversion for Traumatic Vertebral Artery Arteriovenous Fistula: A Case Report

Introduction Arterial pseudoaneurysms and arteriovenous fistulas of intracranial and extracranial vessels are an uncommon occurrence following blunt and penetrating trauma and are commonly treated by vessel sacrifice,dependent on collateral flow1‐3. Others have treated these cases with covered stents4 and flow diversion5. Advances in flow diversion technology have led to their use in other pathologies, including carotid cavernous fistulas6 and vertebral artery pseudoaneurysms7. We present a case of a traumatic arteriovenous fistula of the dominant vertebral artery requiring vessel preservation and reconstruction. Methods A 42‐year‐old male presented with a gunshot wound to the face below the right eye. Trauma imaging identified fractures of the right maxillary sinus and orbital floor. CTA of the head/neck showed a dominant right vertebral artery dissection and pseudoaneurysm with a non‐dominant left vertebral artery (VA), effectively ending in PICA. Results Due to the inefficient supply to the posterior circulation via the left VA, the decision was made to preserve and reconstruct the right VA and the patient was brought to the angiography suite. Angiographically, the patient was noted to have retrograde filling of the posterior circulation, basilar and right VA through the anterior circulation in injection of both ICAs, suggesting decreased antegrade flow from the injured right VA. The right VA was catheterized which showed a high‐flow, high‐grade arteriovenous fistula from the V3 segment with venous drainage into multiple extraspinal cervical and epidural cervical veins. This also identified the fistulous point at the location of the pseudoaneurysm on CTA. The diagnostic catheter was exchanged for a guide catheter, and a Phenom 27 microcatheter (Medtronic; Minneapolis, MN) was navigated into the basilar artery. A Duo microcatheter (Microvention; Aliso Viejo, CA)/Synchro 2 (Stryker; Kalamazoo, MI) standard microwire complex was used to identify the fistulous point and positioned for jailing. A Pipeline Flex 4.75×20mm (Medtronic; Minneapolis, MN) was deployed from the proximal V4 segment across the pseudoaneurysm with persistence of the AVF. A second Pipeline Flex 5×20mm was placed in telescoping fashion with persistence of the AVF. A third Pipeline Flex 5×16mm was placed in telescoping fashion and flow diversion was observed. Using the jailed catheter, the pseudoaneurysm and fistulous point were coil embolized using a combination of helical and 3D HydroSoft coils (Microvention; Aliso Viejo, CA) of varying sizes. Final angiogram demonstrated resolution of the high‐flow AVF, improvement of antegrade flow through the right vertebral artery, and a slow‐flow low‐grade fistulous communication with the posterior extraspinal cervical veins. There were no thromboembolic complications and the patient recovered well from the procedure. Follow‐up angiography at 2 months post‐treatment showed obliteration of the AVF with a small remnant pseudoaneurysm of the right V3 segment. Conclusions Flow diversion is viable in the setting of a traumatic arteriovenous fistula requiring reconstruction of the parent vessel.

High-output heart failure following gunshot injury and traumatic arteriovenous fistula.

Heart failure due to high cardiac output rarely occurs. Few cases of post-traumatic arteriovenous fistula (AVF) as a cause of high-output failure were reported in the literature. Herein, we report a case of 33-year-old male who was admitted to our institution due to symptoms of heart failure. He reported a gunshot injury of the left thigh 4months earlier, when he had been shortly hospitalized and discharged 4days later. Since the gunshot injury he had exertional dyspnea and left leg edema, so the diagnostic procedures were performed. Clinical examination revealed distended neck veins, tachycardia, slightly palpable liver, left leg edema, and thrill over the left thigh. Due to high clinical suspicion, duplex ultrasonography of the left leg was performed that verified femoral AVF. Operative treatment of AVF was made with prompt resolution of symptoms. This case wants to emphasize the importance of proper clinical examination, and duplex ultrasonography in all cases of penetrating injuries.

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.

Protective Arteriovenous Fistula in Traumatic Common Carotid Transection

Penetrating injuries of the neck involving major vessels are associated with high morbidity and mortality. A traumatic arteriovenous (AV) fistula can provide a protective effect by decompressing the injured arterial structure and prevent massive blood loss and airway compression. We present a novel description of CCA (common carotid artery) transection with associated protective AV fistula. Protective AV fistulae have been uncommonly described, and to our knowledge, this is the first case involving carotid transection with associated protective AV fistula ultimately allowing lifesaving operative repair.

Surgical Management of a Large Primary External Iliac Vein Aneurysm

Iliac vein aneurysms are rare, and the true incidence is unknown. Their etiology is either primary or secondary, and secondary aneurysms are often related to a traumatic arteriovenous fistula. They appear to have a male and left-sided predominance. Due to their rarity, the most appropriate surgical management has yet to be elucidated. Here, we highlight a case of a large primary external iliac vein aneurysm successfully repaired with interposition graft.

Point-of-care Ultrasound for the Evaluation of Acute Arterial Pathology in the Emergency Department: A Case Series.

IntroductionThe use of point-of care ultrasound (POCUS) in the evaluation of vascular emergencies including abdominal aortic aneurysm and deep vein thrombosis is well established. However, no current guidelines exist to outline the use of POCUS in the management of acute peripheral arterial pathology.Case SeriesHere, we present a case series that illustrates the utility of POCUS in the assessment of both traumatic and nontraumatic peripheral arterial disease. Direct visualization of the vasculature via B-mode, color Doppler, and pulsed-wave Doppler assisted in the diagnosis of the following: 1) an acute, post-catheterization thrombus of the proximal radial artery; 2) a complete, traumatic radial artery transection; 3) a forearm hematoma with active arterial extravasation; 4) a traumatic arteriovenous fistula; 5) an acute thrombosis of an artery bypass graft; and 6) an infected pseudoaneurysm.ConclusionThe incorporation of POCUS into patient care allowed for rapid identification of significant peripheral arterial pathology and led to changes in clinical management, expedited patient care, and circumvented potentially harmful complications.

An unexpected complication: Acute recanalization of carotico-jugular arteriovenous fistulas previously treated by endovascular therapy

Traumatic arteriovenous fistulas of the neck are treated by the endovascular method or by open surgery according to the clinical presentation of the patient and the degree of emergency. This case report concerns two delayed onset neck fistulas, one between the right common carotid artery and the right internal jugular vein, and the other between the facial artery and the right jugular vein, caused by a previous penetrating neck trauma. Initially, the AV fistula was treated by endovascular intervention using multiple vascular plugs and a covered stent. In this case report, we describe the surgical method we performed on a patient who applied to the emergency department with syncope due to acute recanalization of the old fistula tract four years later.

Arteriovenous Fistula Is Protective in Stab Wounds Involving Major Vessels

<h3>Introduction and Objective</h3> Stab wounds to the neck resulting in major vascular injuries occur in 40% of patients. These are usually associated with significant blood loss and frequently fatal. We describe a patient with multiple stab wounds to neck resulting in almost complete transection of the right common carotid artery (CCA) with a large pseudoaneurysm and an associated internal jugular (IJ) injury, resulting in a "protective" arterio-venous (AV) fistula. Protective AV fistulae are uncommonly described in the literature. We believe this to be a novel description of a CCA transection with associated "protective" AV fistula. <h3>Case Report</h3> A middle-aged male presented to our Level I trauma center after suffering three 1 cm stab wounds to the right side of his neck. The patient arrived via ambulance. The emergency medical services crew provided basic field care including applying supplemental oxygen and covering wounds with dry gauze. Upon arrival, the patient was verbal with a Glasgow Coma Scale score of 15. Heart rate was 122 and blood pressure was 139/91. On initial examination, a large, pulsatile hematoma with a palpable thrill was noted underlying a laceration to the lateral aspect of zone two. A second and third laceration were noted without associated swelling in zone one and zone three, respectively. Minimal external bleeding was noted from all stab wounds. Computed tomography angiography was obtained en-route to the operating room and demonstrated a right CCA injury with a large pseudoaneurysm and AV fistula decompressing into the right internal jugular (IJV) vein. On operative exploration, the right CCA was found to be greater than 90% transected with the proximal and distal ends connected by small amount of bridging adventitia. The right IJV was found to have an approximately 70% wall transection and the vagus nerve was totally transected. The CCA and IJV were repaired in a primary end-to-end fashion. The vagus nerve was also repaired. The patient had an uneventful postoperative course and was discharged home on hospital day three. On follow-up visit after 6 weeks patient was doing well with no neurovascular deficit. <h3>Discussion</h3> Penetrating injuries of the neck involving major vessels are associated with high morbidity and mortality. A traumatic AV fistula can provide a protective effect by decompressing the injured arterial structure and prevent massive blood loss and airway compression. Protective AV fistulae have been uncommonly described, and to our knowledge, this is the first case involving a >90% carotid transection with associated "protective" AV fistula ultimately allowing life-saving operative repair.

A response to Dr. Trager and Dr. Mattox commentary regarding “An Unusual Suspect for a Traumatic Arteriovenous Fistula in the Left Vertebral Artery”

A response to Dr. Trager and Dr. Mattox commentary regarding “An Unusual Suspect for a Traumatic Arteriovenous Fistula in the Left Vertebral Artery”

Shrapnel Injury Leading to Posterior Tibial Arteriovenous Fistula: A Complex Repair

Traumatic arteriovenous fistulas (AVFs) are a rare entity in vascular surgery and can lead to congestive heart failure, venous hypertension, severe leg swelling, and limb threatening ischemia. We present a case of a posterior tibial (PT) AVF associated with a popliteal artery aneurysm (PAA), requiring a bypass graft, ligation of the AVF, and a PT interposition graft.

Anatomy of the Middle Meningeal Artery

AbstractIntroduction The middle meningeal artery (MMA) is an important artery in neurosurgery. As the largest branch of the maxillary artery, it provides nutrition to the meninges and to the frontal and parietal regions. Diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (TAVF), Moya-Moya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine, and meningioma, may be related to the MMA. The aim of the present study is to describe the anatomy of the MMA and to correlate it with brain diseases.Methods A literature review was performed using the PubMed, Scielo, Scientific Direct, Ebsco, LILACS, TripDataBase and Cochrane databases, with the following descriptors: neurosurgery, neuroanatomy, meninges and blood supply.Discussion The MMA is embedded in a cranial groove, and traumatic or iatrogenic factors can result in MMA-associated pseudoaneurysms or arteriovenous fistulas (AVFs). In hemodynamic stress, true aneurysms can develop. Arteriovenous fistulas, pseudoaneurysms, and true aneurysms can be effectively treated by endovascular or surgical removal. In MMD, the MMA plays a role in the development and in the improvement of collateral circulation. Finally, in cases of CSDH, when standard surgery and drainage fail, MMA embolization can constitute a great alternative.Conclusion The MMA is a relevant structure for the understanding of neurosurgical diseases. In conclusion, every neurosurgeon must know the anatomy of the MMA sufficiently to correlate it with the diagnosed pathology, thus obtaining treatment effectiveness and preventing brain lesion.

Traumatic Common Carotid-jugular Fistula In A 6-year-old Child: Rare Cause Of Pulsatile Neck Mass

Background: Traumatic common carotid artery-jugular vein fistula is an uncommon clinical entity that may follow penetrating neck injury. It is rarely seen in children. It usually presents with a pulsatile neck mass following a history of trauma to the neck. It may present with pulsatile mass, thrill on palpation and murmurs on auscultation. There may be a neurologic deficit, which may vary from hemiparesis to hemiplegia. We present a case of traumatic arteriovenous fistula that presented as pulsatile anterior neck swelling in a school child. Case Presentation: A 6 year old male child, presented with a 3 days history of penetrating gunshot injury to the right side of the neck, as a result of accidental discharge from a gun during a marriage ceremony. The patient said to have bled profusely from the site of injury and had transient loss of consciousness. Examination revealed a healing wound and a slight swelling on the right side of the neck just anterior to the anterior border of the sternocleidomastoid muscle. The mass was pulsatile, with palpable thrill and bruit on auscultation. Colour doppler ultrasound demonstrated an abnormal connection with abnormal blood flow from the right common carotid artery to the right internal jugular vein. He was successfully treated surgically by neck exploration, excision of the fistula, and repair of defects in both vessels. Conclusions: Traumatic carotid-jugular fistula following gunshot injury is rarely seen in children. Guns should not be used or left unattended to in crowds so as to forestall future occurrence of accidental discharge that could lead to avoidable injuries. We recommended strict adherence to the rules and regulations guarding the use of firearms by civilians.

The argument for more aggressive management of traumatic arteriovenous fistulas

In the article published in this issue of JVS, the authors, led by senior author Juan Asensio, report that an astounding 13% of 274 patients with traumatic arteriovenous fistulas (AVFs) presented with heart failure (HF).1 One could certainly argue that potential sources of bias were present, such as publication bias or loss to follow-up bias, which could have artifactually inflated this estimate.2,3 However, it is also possible that the rate of developing HF as a late sequela of certain traumatic AVFs might be even greater than previously thought.