Distal Femoral Arteriovenous Fistula with Iliac Vein Thrombosis after Blunt Trauma

Abstract

A 39-year-old woman arrived at our emergency department, complaining of severe pain and swelling of her left leg. She had slipped down stairs and injured on her left leg about 3 months ago. Computed tomography angiography showed left distal superficial femoral artery's pseudoaneurysm with arteriovenous fistula and thrombotic occlusion of left common iliac vein. We decided to do endovascular intervention due to severe venous hypertension and chronic inflammation around the fistula. The femoral arteriovenous fistula was closed via stent-graft (7 mm×5, 9 mm×5 cm) deployment. The occluded left iliac vein was reopened by nitinol metal stenting (12 mm×4 cm, 14 mm×4 cm). The authors report a very rare case of femoral arteriovenous fistula combined with iliac vein thrombosis developed after a blunt trauma.

Keywords: Fistula; Thrombosis; Trauma; blunt.

Fig. 1

Computed tomography angiography shows (A) left distal femoral artery’s pseudoaneurysm with fistula connection and occlusion of left common iliac vein. (B) Partial thrombus (white arrow) in pseudoaneurysm. (C) Thrombosis in left common iliac vein.

Fig. 2

Intra-interventional angiography. (A) Distal femoral arteriovenous fistula was completely closed after two stent-graft (7 mm×5 cm, 9 mm×5 cm) deployments. The pseudoaneurym was partially filled with thrombus (arrow). (B) Thrombotic occlusion of left iliac vein was recanalized via thrombus aspiration and overlapped self-expandable nitinol stents (12 mm×4 cm, 14 mm×4 cm) deployment.

Fig. 3

Three year post intervention computed tomography angiography shows patent left femoral artery but somewhat intra-stent restenosis is also observed.