Surgery for Traumatic Lower Extremity Arteriovenous Fistulas

Traumatic arteriovenous fistulas (AVFs) of the lower extremities arise from concurrent injury to adjacent arteries and veins. If left untreated, they can result in both local and systemic hemodynamic disturbances. Endovascular and hybrid techniques have improved the management of AVFs. Objective. To present our experience in the diagnosis and surgical treatment of lower extremity traumatic AVFs, including cases associated with false aneurysms, and to evaluate the short- and long-term outcomes of open, endovascular, and hybrid interventions based on the location and nature of the vascular injury. Material and methods. We performed a retrospective review of 35 patients who underwent surgery for traumatic AVFs. Isolated AVFs were identified in 18 patients (Group 1), while the remaining 17 (Group 2) presented with fistulas associated with pseudoaneurysms. The choice of open, endovascular, or hybrid intervention was individualized based on the anatomic site and morphological characteristics of the injury. Results. The mean interval from injury to surgery was 11.7±5.8 months in Group 1 and 8.3±4.2 months in Group 2. Clinically significant right sided cardiac volume overload was documented in only 2 patients (5.7%), both from Group 1 with proximal fistulas. Technical success, defined as complete occlusion of the fistula confirmed by CT angiography on postoperative days 5—7, was achieved in all 35 patients (100%). Clinical success, characterized by the disappearance of the systolic diastolic bruit, a reduction in extremity girth, and the restoration of normal venous flow on duplex ultrasound was observed in 33 patients (94.3%). Chronic venous insufficiency persisted during long-term follow-up in 2 patients (5.7%) with long-standing crural AVFs. The overall complication rate was 5.5%. Conclusion. Surgical treatment of lower extremity traumatic AVFs using open, endovascular, and hybrid interventions enables technical and clinical success with a low complication rate in the majority of patients.