Delayed Discovery and Repair of a Traumatic Arteriovenous Fistula (AVF) 58 Years After a Combat Explosion

An acquired arteriovenous fistula (AVF) is an abnormal connection between the arterial and venous systems, with delayed clinical presentation being rare. We present a 79-year-old male patient who was incidentally found to have a right iliac arteriovenous fistula (AVF) during imaging workup concerning for appendicitis, which would have been a rare diagnosis for a patient in this age group. He denied symptoms suggestive of a fistula and had a normal physical exam, making this an unusual asymptomatic presentation discovered 58 years after a combat blast injury. Endovascular repair required through-and-through vascular access and the deployment of an Amplatzer vascular plug for complete occlusion. Follow-up imaging confirmed decreased venous filling of the AVF, and the patient remains complication-free. This case highlights the need to be vigilant in patients with a history of remote trauma and the effectiveness of endovascular management for large AVFs.