Giant Traumatic External Iliac Artery-Femoral Arteriovenous Fistula

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J INVASIVE CARDIOL 2024. doi:10.25270/jic/24.00298. Epub November 20, 2024.

A 53-year-old woman presented with shortness of breath and fatigue for 1 week. The patient had a medical history of left thigh trauma for more than 20 years. Cardiac auscultation indicated a grade III/6 systolic murmur audible in the aortic valve auscultation zone. Laboratory examination revealed an N-terminal prohormone BNP (NT-proBNP) level of 2558 pg/mL (reference range＜125 pg/mL). Computed tomography angiography (CTA) images suggested a left external iliac arteriovenous fistula (AVF) and a giant iliac vein aneurysm (Figure A, B), and a femoral arteriovenous fistula with extensive tortuous and dilated venous collateral pathways (Figure C, D). Left lower extremity arteriography confirmed the multiple left arteriovenous fistulas (Figure E, Video).

The patient was successfully treated with an 80 x 24-mm Endurant stent-graft (Medtronic) closure of the left iliac arteriovenous fistula and surgical repair of the femoral AVF. The postoperative CTA reexamination suggested that the arteriovenous fistula had been wholly closed (Figure F). The patient's postoperative course was clinically uneventful, and she was discharged after 5 days. At the 6-month follow-up, the symptoms were significantly alleviated.

Post-traumatic iliac artery-femoral AVF is a rare entity that in most cases may be delayed for diagnosis.¹ Patients may present with vessel dilation, forming pulsatile varices, venous hypertension, distal ischemia, and congestive heart failure.² The early diagnosis and treatment of AVFs is crucial for large AVFs, as they pose a heightened risk for adverse complications, including thrombosis and heart failure.³ Diagnostic modalities include ultrasound, CT angiography, and venography,⁴ and they are typically treated through covered stents, coil embolization, and open surgical repair.

Affiliations and Disclosures

Leizhi Ku, MD¹; Yuhang Wang, MD¹; Zheng Liu, MD¹; Xiaojing Ma, PhD²

From the Departments of ¹Radiology and ²Echocardiography, Wuhan Asia Heart Hospital Affiliated Wuhan University of Science and Technology, Wuhan, China.

Dr Ku and Dr Wang contributed equally to the article.

Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.

Funding: This work is funded by the 2021 General Project Health and Family Planning Commission of Wuhan municipality scientific research project (WX21D46), Wuhan Clinical Medical Research Center for Cardiovascular Imaging (CMRC202307).

Consent statement: The authors confirm that informed consent was obtained from the patient for the procedures described in this manuscript.

Address for correspondence: Xiaojing Ma, PhD, Department of Echocardiography, Wuhan Asia Heart Hospital Affiliated Wuhan University of Science and Technology, No.753 Jinghan Road, Hankou District, Wuhan 430022, China. Email: klz1534292102@163.com

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