Traumatic false aneurysm and arteriovenous fistula of the profunda femoris artery: surgical management and review of the literature

Abstract

Successful surgical repair of a false aneurysm and an arteriovenous fistula of the deep femoral vessels has been achieved 8 years after the initial injury. A review of the literature disclosed 20 other similar cases from military and civilian practice; ligation of the artery was utilized 14 times with generally poor results when long-term follow-up was available. Most vascular wounds were due to fragments, as was the case in our patient, and involvement of the deep femoral vessels was recognized more frequently in delayed complications than in acute injuries. Ten cases of false aneurysm of the deep femoral artery without arteriovenous fistula have been found to be associated with fracture or orthopedic precedures. Mild intravascular hemolysis was present in our patient and was corrected promptly after operation. Only one other such case was found in the literature. The profunda femoris artery, which was dilated and elongated, resumed a normal caliber in its proximal segment on arteriography performed one year after the operation. Preservation of the deep femoral artery may be of significance for a good clinical result in the treatment of arteriovenous fistulas and is of special interest in view of its potential importance in reconstructive procedures for atherosclerotic occlusive disease. Early diagnosis and treatment of arteriovenous fistulas for the prevention of hemodynamic, systemic, and structural changes in the vessel wall are advocated.