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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Main Authors: Rakan Nasser Eldine, Hassan Dehaini, Jamal J Hoballah, Fady Fayez Haddad
Format: Article
Language:English
Published: BMC 2020-08-01
Series:BMC Surgery
Subjects:
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.
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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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AT jamaljhoballah managementofdualtraumaticarterialvenousfistulafromasingleshotguninjuryacasereportandliteraturereview
AT fadyfayezhaddad managementofdualtraumaticarterialvenousfistulafromasingleshotguninjuryacasereportandliteraturereview