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Femoral arteriovenous fistula

Case contributed by Hidayatullah Hamidi
Diagnosis certain

Presentation

History of bullet injury 20-years ago.

Patient Data

Age: 55 years
Gender: Male

Abdominal aorta:

Tortuosity, dilatation, and towards left side displacement of the lower abdominal aorta distal to the origin of the renal arteries: The lumen of the dilated distal aorta measures 37 mm in diameter. The lumen of the normal upper aorta at the level of renal arteries measures 22 mm in diameter.

Right lower extremity:

Dilatation and tortuosity of the right common iliac, right external iliac, right common femoral, and right femoral arteries are noted.

Early opacification and dilatation of right lower limb venous system representing arterio-venous fistulation.

Luminal dilatation of the right iliac vein measuring about 10 x 6 x 5 cm. No luminal thrombosis is seen.

As the dilated arteries and veins are similarly opacified and are in very close contact, the accurate site or sites of arterio-venous fistulation cannot be clearly seen, however; it is most probably at the site of the foreign body.

IVC is also dilated.

Soft tissues:

There are 2 metallic density foreign bodies in the right leg. The one in the anterior muscle compartments of the proximal thigh measures about 11 mm. The second in the medial muscle compartment of the right lower thigh in close vicinity of the right distal femoral artery and vein measures 16 mm.

Soft tissue edema of the right lower limb is noted.

Case Discussion

Arteriovenous fistula of the right femoral artery and right femoral vein with proximal arterial and venous dilatation, presumably secondary to a gunshot wound. 

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