Open surgical treatment of a chronic traumatic arteriovenous fistula in the lower extremity: A case report.

Introduction And Importance: A traumatic arteriovenous fistula (TAVF) is a vascular injury where an artery and a vein become abnormally connected. Although endovascular intervention is often the first choice for TAVF, some special cases still require open surgery.

Case Presentation: A 65-year-old man developed a chronic AVF in the lower superficial femoral artery (SFA) one year after a farming accident. He had recurrent swelling and pruritus in his right lower limb. Angiography showed dilation of the proximal artery and distal vein, with narrowing of the distal artery. Under general anesthesia, the patient underwent open surgical repair, including ligation of the fistula between the proximal and distal ends of the superficial femoral artery. After follow-up, the patient's swelling and itching improved, and there were no signs of further venous dilation.

Discussion: A TAVF shunts arterial blood directly into the venous system, reducing distal arterial flow and causing ischemic changes in the limb. If left untreated, the high-flow state may lead to heart failure or aneurysmal changes. Embolization is commonly used for TAVFs, but in this patient, the fistula's short diameter made embolization difficult and raised the risk of embolus migration. Therefore, open surgery was chosen. During follow-up, the fistula disappeared, and arterial diameters returned closer to normal, while no further abnormal changes were seen in the vein.

Conclusion: Angiography is the gold standard for diagnosing AVFs. Although minimally invasive intervention is often preferred, open surgery remains important for complex TAVFs.