TRAUMATIC ARTERIOVENOUS FISTULA-A LATE COMPLICATION OF VASCULAR INJURIES

Traumatic Arteriovenous Fistula

Abstract

Objective: To evaluate the causes, site, duration between the time of injury and presentation and management of traumatic arteriovenous fistula (AVF).
Study Design: A descriptive study.
Place and Duration of study: Department of vascular surgery at Combined Military Hospital Rawalpindi from March 2010 to Dec 2011 and Combined Military Hospital Kharian Cantt from Jan 2012 to March 2014.
Material and Methods: All the cases of traumatic AVF fistula which reported during this study period were included. Congenital arteriovenous (AV) malformations and fistula for hemodialysis access were excluded from this study. All the cases were evaluated with computerized tomography (CT) angiography or conventional angiography and managed with various open vascular surgical techniques and their results were assessed.
Results: Fourteen patients of traumatic AV fistula underwent various open vascular repairs. Age of patients ranged from 16 to 75 years with average age of 34.3 ± 14.5 years. Male to female ratio was 3.6:1. Penetrating injuries were the commonest cause i.e. 11 (78.6%). Time interval between injury and presentation in hospital ranged from 4 months to 25 years with average time interval 4.3 years. Lower limb vessels were affected in 10 (71.4%) the upper limb in 1 (7.1%) and neck vessels in 2 (14.3%) and 1 (7.1%) case of post appendectomy AVF between inferior epigastric artery and adjacent vein. Superficial femoral artery and vein was the most frequently involved vessels i.e. 7 (50%) cases.
Conclusion: Low velocity penetrating vascular trauma was the commonest cause of traumatic AV fistula. Lower extremities were the most frequently involved site. In most of the cases traumatic AV fistula presents late with its complications. Surgical intervention includes the excision of fistula and restores the continuity of the involved artery and vein with interposition reverse autogenous vein graft or prosthetic graft.