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Traumatic arteriovenous fistula. Case report.

H Dedichen¹, E Thaulow, A Naess

¹Department of Cardiovascular Surgery, Ullevaal Hospital, Oslo, Norway.

Acta Chirurgica Scandinavica

|April 1, 1989

Summary

A large arteriovenous fistula, caused by a bullet wound, led to heart strain and leg swelling. Surgical closure resolved these symptoms, highlighting the impact of vascular trauma on cardiovascular and venous health.

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Area of Science:

Vascular Surgery
Cardiology
Trauma Medicine

Background:

Arteriovenous fistulas (AVFs) can develop after penetrating trauma, such as gunshot wounds.
Large AVFs can lead to significant hemodynamic changes, including increased cardiac output and potential heart strain.
Delayed presentation of AVFs can result in chronic venous insufficiency and cardiovascular complications.

Observation:

A young man presented 6 years post-bullet wound with symptoms of exertional dyspnea, palpitations, and right leg venous insufficiency.
Diagnostic angiography revealed a wide ( >20 mm) arteriovenous fistula between the right femoral artery and vein.
Cardiac examination showed moderate cardiac hypertrophy and a markedly elevated cardiac output of 14.8 L/min.

Findings:

Surgical division and closure of the AVF were performed.
Intraoperative measurement showed a significant flow of 8 L/min in the right external iliac artery prior to fistula closure.
Post-closure, immediate resolution of cardiac symptoms and gradual improvement of venous insufficiency were observed.

Implications:

This case underscores the long-term cardiovascular and venous sequelae of untreated traumatic arteriovenous fistulas.
Prompt diagnosis and surgical management of large AVFs are crucial for preventing or reversing associated cardiac and venous complications.
Effective treatment of AVFs can restore normal hemodynamics and significantly improve patient quality of life.

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