Arteriovenous fistula (AVF) between the external iliac artery (AIE) and external iliac vein (VIE) after trauma is rare. Rarely, it occurs that fistula is accompanied by an aneurysm of external iliac artery. Two thirds of AVF occur after stab wounds, one third after puncture wounds and only one percent after blunt injuries.
A 32-year-old male visited a vascular surgeon because of the swelling on his right leg and severe pain in his thigh. Three years before, he was admitted to Surgical Clinics (Clinics of Neurosurgery, Orthopaedic and Plastic Surgery) after a fall from a motorbike, when he sustained a pelvic distortion with a haematoma on the right thigh. On admission, the patient was conscious and oriented. The right leg was swollen and painful to touch in the upper thigh region. At the level of surgical scar, a thrill was verified by palpation, and subsequently confirmed by Doppler sonography, on the occasion of which the presence of aneurism in the iliac region and indirect signs of artriovenous fistula were found. Angiography revealed the presence of AVF between the right AIE and VIE. After confirming the diagnosis, the patient was operated. The postoperative course passed uneventful. Control MSCT was performed after a month, when a patient graft was verified, as well as the absence of AVF.
Traumatic arteriovenous fistulas are rare. Unless they are recognized in time, they over time lead to arterial and/or venous insufficiency, impeding the definite treatment. In order to set an early diagnosis, especially in multiple injuries and politraumas, diagnostical CT with CT angiography is the method of choice. As a rule, the treatment of AVF is surgical, and postsurgical recovery justifies the treatment method. Aneurysm that accompanies AVF has to be resected during AVF treatment, as it progresses over time.
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