Traumatic arteriovenous fistula in the forearm

A 25-year-old female presented with a 3-month history of venous ectasia and vascular murmur in the left arm. Her symptoms had begun after she sustained blunt trauma to the forearm. Computed tomographic angiography with three-dimensional reconstruction demonstrated a tortuous arteriovenous fistula (Panel A, long arrow) in the vicinity of the ulnar artery and early contrast filling of the veins (Panel A, short arrows) during the arterial phase. Digital subtraction angiography revealed a high-flow arteriovenous fistula (Panel B, long arrow) with ulnar artery origin. Through various looping and vascular angulations, it finally drained into the basilic vein (Panel B, arrowhead) and cephalic vein (Panel B, short arrow). Surgical arteriovenous fistula resection (Panel C, arrow; Panel D) and repair of the ulnar artery were performed. Histopathology of the surgical specimen confirmed the diagnosis of arteriovenous fistula. The patient’s postoperative course was uneventful, and she remained asymptomatic during follow-up.

Panel A Panel B Panel C Panel D

An arteriovenous fistula is an abnormal vascular communication with shunting of blood from an artery to a vein. There are multiple potential causes of arteriovenous fistulas, including: congenital anomalies; surgically created access for hemodialysis treatment; or pathological processes, such as trauma, neoplasm, or infection of the vulnerable portion of the arteriovenous wall. ¹ The treatment approach to the symptomatic arteriovenous fistula may involve surgical resection or transcatheter embolization.

‘Images in vascular medicine’ is a regular feature of Vascular Medicine. Readers may submit original, unpublished images related to clinical vascular medicine. Submissions may be sent to: Mark A Creager, Editor in Chief, Vascular Medicine, via the web-based submission system at http://mc.manuscriptcentral.com/vascular-medicine