A Rare Case of Traumatic Innominate-Innominate Arteriovenous Fistula

Area of Science:

• Vascular Surgery
• Cardiovascular Medicine
• Trauma Surgery

Background:

• Presents a rare case of traumatic innominate artery-innominate vein fistula.
• Details a delayed presentation of this arteriovenous fistula following a stab wound to the neck.
• Highlights the diagnostic challenges associated with this rare vascular injury.

Observation:

• A 23-year-old patient presented with fatigue and dyspnea 3 years post-injury.
• Clinical examination revealed a wide pulse pressure, bounding pulses, and a continuous murmur.
• Diagnostic workup included chest X-ray, echocardiography, CT angiography, and cardiac catheterization.

Findings:

• Confirmed a complex 8-mm arteriovenous fistula between the left innominate vein and proximal innominate artery.
• Demonstrated a significant left-to-right shunt with multiple tortuous channels.
• Radiological and cardiac investigations were crucial for diagnosis and surgical planning.

Implications:

• Emphasizes the need for a high index of suspicion in diagnosing traumatic innominate-innominate arteriovenous fistulas.
• Successful surgical ligation and division achieved through median sternotomy without cardiopulmonary bypass.
• Underscores that prompt diagnosis and appropriate management, including surgical or endovascular approaches, are key to favorable outcomes.