A traumatic arteriovenous fistula causing venous insufficiency

Chronic leg ulcers are one of the clinical manifestations of untreated traumatic arteriovenous fistula (AVF). Ulcers due to secondary venous etiology like AVF are rare and easily missed. We present the case of a 31-year-old male who sustained a gunshot injury to the knee 12 years ago. Despite the absence of varicose veins, he presented with a neglected venous ulcer persisting for 2 years. A computed tomographic venogram revealed an AVF in the supra-genicular popliteal artery and vein. The patient subsequently underwent open surgical correction. Complete ulcer healing was achieved in 6 months. This case underscores the potential for a high-flow post-traumatic AVF to induce a non-healing venous ulcer even in the absence of apparent varicose veins. Secondary causes of chronic venous diseases are often overlooked, leading to complications. Early recognition is crucial to preventing further morbidity.