Late arterial aneurysm proximal to corrected post-traumatic arteriovenous fistula

A 60 year-old man presented with an extensive iliofemoral aneurysm discovered 11 years after the closure of a long-standing (28 years) post-traumatic arteriovenous fistula (AVF). Treatment by exclusion and bypass was successful. Fifteen other such cases have been reported in the literature in the last 15 years. While cardiomegaly is reversible once the AVF has been closed, arteriomegaly continues to increase or may begin only after closure. The mechanism for this phenomenon is debated. All arterial dilatations discovered during or after closure of AVF must be treated because of the risk of rupture. Prevention implies early treatment of all AVF. If the AVF is long-standing, the caliber of the artery proximal to the site of repair must be carefully measured and all dilated segments replaced. The patient should be warned of the possibility of late arteriomegaly proximal to the site of closure.