[Arteriovenous fistula: an uncommon cause of leg ulcers]

A 69-year-old woman presented with a therapy-resistant ulcer on the medial aspect of her left ankle present for 2 years. Previously there had been a blood vessel tumor at the same site, but it had regressed almost completely in adolescence following a bacterial infection. A whirring flow sound was e heard over the ulcer. Numerous arteriovenous connections in the area of the ulcer were shown in the form of vascular convolutions with duplex sonography and angiography. The diagnosis of arteriovenous fistula was made. In addition, there was calcinosis around the ulcer. Successful therapy consisted of excision of the ulcer and the underlying calcinosis, and of ligature of the multiple arteriovenous connections. Our patient demonstrates that smaller arteriovenous fistulas may exist for decades without symptoms. The classification, clinical patterns, diagnostic approach, possible complications (bleeding, ulceration) and therapy of the rare arteriovenous fistulas are discussed.