Management of dual traumatic arterial-venous fistula from a single shotgun injury: a case report and literature review
Abstract Background Traumatic arteriovenous fistula (TAVF) is an uncommon vascular entity that arises in various locations, often from penetrating injuries, with a wide spectrum of signs and symptoms. This case report highlights the importance of suspecting multiple TAVFs after a single gunshot woun...
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BMC
2020-08-01
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Series: | BMC Surgery |
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Online Access: | http://link.springer.com/article/10.1186/s12893-020-00833-5 |
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author | Rakan Nasser Eldine Hassan Dehaini Jamal J Hoballah Fady Fayez Haddad |
author_facet | Rakan Nasser Eldine Hassan Dehaini Jamal J Hoballah Fady Fayez Haddad |
author_sort | Rakan Nasser Eldine |
collection | DOAJ |
description | Abstract Background Traumatic arteriovenous fistula (TAVF) is an uncommon vascular entity that arises in various locations, often from penetrating injuries, with a wide spectrum of signs and symptoms. This case report highlights the importance of suspecting multiple TAVFs after a single gunshot wound, especially if it involves pellets. It also sheds light on adapting treatment, whether endovascular or open repair, to the location and characteristics of each fistula. Case presentation A 35-year-old male, with history of shotgun wound 5 months earlier, presented to our clinic with right lower extremity (RLE) edema and pain. Arterial duplex scan and subsequent angiogram showed two TAVFs at the popliteal and posterior tibial (PT) arteries, both of which could not be exactly localized with a computed tomography angiography (CTA) due to artifacts. The fistula connecting the posterior tibial artery (PTA) and vein was repaired endovascularly using a covered-stent, while the fistula between the popliteal artery and vein was repaired surgically. Postoperative follow-up at 3 months showed no arteriovenous fistula (AVF), patent vessels and distal stent stenosis at the PTA. Conclusions Patients who sustain gunshot injuries with shrapnel or pellets and develop TAVF consequentially need to be followed up with the possibility of multiple AVFs in mind. Arterial duplex scan is highly sensitive to detect those AVFs, yet angiography remains gold standard, particularly with extensive metal artefacts. Endovascular repair, when feasible, should be considered first, unless the patient is unstable or has anatomical constraints that increase the risk of complications. Lastly, surgeons should be weary of deep venous thrombosis (DVT), the Branham effect and arterial aneurysmal dilation postoperatively. |
first_indexed | 2024-12-19T00:28:49Z |
format | Article |
id | doaj.art-3a099c99a28a479e8355a66370ebe6a8 |
institution | Directory Open Access Journal |
issn | 1471-2482 |
language | English |
last_indexed | 2024-12-19T00:28:49Z |
publishDate | 2020-08-01 |
publisher | BMC |
record_format | Article |
series | BMC Surgery |
spelling | doaj.art-3a099c99a28a479e8355a66370ebe6a82022-12-21T20:45:09ZengBMCBMC Surgery1471-24822020-08-012011810.1186/s12893-020-00833-5Management of dual traumatic arterial-venous fistula from a single shotgun injury: a case report and literature reviewRakan Nasser Eldine0Hassan Dehaini1Jamal J Hoballah2Fady Fayez Haddad3Division of Vascular & Endovascular Surgery, Department of Surgery, American University of Beirut Medical CenterDivision of Vascular & Endovascular Surgery, Department of Surgery, American University of Beirut Medical CenterDivision of Vascular & Endovascular Surgery, Department of Surgery, American University of Beirut Medical CenterDivision of Vascular & Endovascular Surgery, Department of Surgery, American University of Beirut Medical CenterAbstract Background Traumatic arteriovenous fistula (TAVF) is an uncommon vascular entity that arises in various locations, often from penetrating injuries, with a wide spectrum of signs and symptoms. This case report highlights the importance of suspecting multiple TAVFs after a single gunshot wound, especially if it involves pellets. It also sheds light on adapting treatment, whether endovascular or open repair, to the location and characteristics of each fistula. Case presentation A 35-year-old male, with history of shotgun wound 5 months earlier, presented to our clinic with right lower extremity (RLE) edema and pain. Arterial duplex scan and subsequent angiogram showed two TAVFs at the popliteal and posterior tibial (PT) arteries, both of which could not be exactly localized with a computed tomography angiography (CTA) due to artifacts. The fistula connecting the posterior tibial artery (PTA) and vein was repaired endovascularly using a covered-stent, while the fistula between the popliteal artery and vein was repaired surgically. Postoperative follow-up at 3 months showed no arteriovenous fistula (AVF), patent vessels and distal stent stenosis at the PTA. Conclusions Patients who sustain gunshot injuries with shrapnel or pellets and develop TAVF consequentially need to be followed up with the possibility of multiple AVFs in mind. Arterial duplex scan is highly sensitive to detect those AVFs, yet angiography remains gold standard, particularly with extensive metal artefacts. Endovascular repair, when feasible, should be considered first, unless the patient is unstable or has anatomical constraints that increase the risk of complications. Lastly, surgeons should be weary of deep venous thrombosis (DVT), the Branham effect and arterial aneurysmal dilation postoperatively.http://link.springer.com/article/10.1186/s12893-020-00833-5TraumaticArteriovenous fistulaPosterior tibial arteryPopliteal arteryCase report |
spellingShingle | Rakan Nasser Eldine Hassan Dehaini Jamal J Hoballah Fady Fayez Haddad Management of dual traumatic arterial-venous fistula from a single shotgun injury: a case report and literature review BMC Surgery Traumatic Arteriovenous fistula Posterior tibial artery Popliteal artery Case report |
title | Management of dual traumatic arterial-venous fistula from a single shotgun injury: a case report and literature review |
title_full | Management of dual traumatic arterial-venous fistula from a single shotgun injury: a case report and literature review |
title_fullStr | Management of dual traumatic arterial-venous fistula from a single shotgun injury: a case report and literature review |
title_full_unstemmed | Management of dual traumatic arterial-venous fistula from a single shotgun injury: a case report and literature review |
title_short | Management of dual traumatic arterial-venous fistula from a single shotgun injury: a case report and literature review |
title_sort | management of dual traumatic arterial venous fistula from a single shotgun injury a case report and literature review |
topic | Traumatic Arteriovenous fistula Posterior tibial artery Popliteal artery Case report |
url | http://link.springer.com/article/10.1186/s12893-020-00833-5 |
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