Successful Treatment of a Chronic Venous Ulcer Caused by an Undiagnosed Arteriovenous Fistula: A Case Report

Abstract

This case report presents a 53-year-old male patient with a chronic venous ulcer (CVU) on his left lower limb that persisted for over 10 years despite various treatments. The patient had a history of a gunshot wound to the left femoral area 12 years prior. Despite regular follow-ups and multiple interventions, including debridement and split-thickness skin grafting, the ulcer showed poor healing. Further diagnostic imaging, including angiography and computed tomography, revealed an previously undiagnosed arteriovenous fistula (AVF) at the left external iliac artery and femoral artery level. The patient underwent a minimally invasive endovascular intervention involving percutaneous transluminal angioplasty and stent graft placement. This approach successfully closed the AVF, significantly reducing venous hypertension and promoting wound healing. One month after operation, the CVU showed complete healing without recurrence. This case underscores the importance of considering AVFs in the differential diagnosis of CVUs, especially in patients with a history of trauma or surgery. It also highlights the effectiveness of endovascular techniques in treating complex vascular anomalies and their associated complications.

Keywords: arteriovenous fistula; chronic venous ulcer; endovascular stent graft; lower extremity wound healing; posttraumatic vascular injury; venous hypertension.