A traumatic arteriovenous fistula causing venous insufficiency

Area of Science:

• Vascular Surgery
• Trauma Surgery
• Dermatology

Background:

• Chronic leg ulcers are common, but those stemming from secondary venous causes like arteriovenous fistulas (AVFs) are rare and often misdiagnosed.
• Traumatic AVFs, particularly high-flow ones, can present insidiously, leading to delayed diagnosis and prolonged morbidity.

Observation:

• A 31-year-old male with a history of knee gunshot injury 12 years prior presented with a 2-year-old neglected venous leg ulcer.
• Despite the absence of typical varicose veins, imaging revealed a supra-genicular popliteal arteriovenous fistula.

Findings:

• Open surgical correction of the traumatic arteriovenous fistula was performed.
• Complete healing of the chronic venous leg ulcer was achieved within 6 months post-surgery.

Implications:

• This case highlights that high-flow traumatic AVFs can cause non-healing venous ulcers, even without visible varicose veins, emphasizing the need to consider secondary causes.
• Early recognition and management of AVF-induced venous ulcers are critical to prevent complications and improve patient outcomes.
• Undiagnosed secondary causes of chronic venous disease can lead to significant morbidity; thorough investigation is essential.