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Intermittent claudication secondary to a traumatic arteriovenous fistula
D Kotelis1, K Klemm, H von Tengg-Kobligk
1Dept. of Vascular and Endovascular Surgery, University of Heidelberg, Heidelberg, Germany. drosos_kotelis@med.uni-heidelberg.de
VASA. Zeitschrift Fur Gefasskrankheiten
|March 25, 2008
Summary
A rare cause of leg pain, peripheral microembolism from an old arteriovenous fistula (AVF) led to artery blockage. Treatment involves exercise and antiplatelet medication, not surgery.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Diagnostic Imaging
Background:
- Arteriovenous fistula (AVF) formation is a known complication of arterial trauma.
- Delayed diagnosis and treatment of traumatic AVFs can lead to long-term complications.
- Atherosclerosis is the most common cause of peripheral artery disease and claudication.
Observation:
- A 63-year-old man with a 20-year history of untreated traumatic AVF presented with calf claudication.
- Imaging revealed an aneurysmal infrarenal aorta with partial thrombosis and occlusion of the right popliteal and infrapopliteal arteries.
- No signs of atherosclerosis were present in the patient.
Findings:
- The patient's claudication was attributed to peripheral microembolism originating from the aneurysmal aorta and major leg arteries.
- This represents a rare, nonatherosclerotic cause of lower extremity artery occlusion.
- The occlusion of the right popliteal artery segment 2 and infrapopliteal arteries was confirmed by angiography.
Implications:
- This case highlights the importance of considering nonatherosclerotic causes of peripheral artery disease, especially in patients with a history of arterial trauma.
- Management strategies for such cases may differ from standard atherosclerosis treatment.
- Exercise training and antiplatelet therapy were initiated, with no indication for arterial revascularization at this time.
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