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 6 months to 20 years. 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.