Chronic venous insufficiency as a possible clinical manifestation of a post-traumatic lower limb arteriovenous fistula

Post-traumatic arteriovenous fistulas are rare and often difficult to diagnose due to specific pathogenesis and miscellaneous symptoms. We report the case of a post-traumatic arteriovenous fistula (AVF) of the femoral vessels in the lower third of the thigh in a 50-year-old male patient who presented with limb edema, pain, and a trophic ulcer, and was initially admitted to a phlebologist for invasive treatment of varicose veins and chronic venous insufficiency (CVI). Past medical history, precise physical examination, vascular testing, and duplex sonography followed by angiography revealed AVF; attempts to exclude AVF during the open procedure failed. The patient was then subjected to endovascular treatment using a covered stent. After 6 months the patient was free from edema and pain with complete healing of the trophic ulcer. Patients with CVI signs such as limb edema, pain, and trophic ulcers following trauma should be screened for post-traumatic lower limb arteriovenous fistulas. Thorough anamnesis, optimal sonography skills, extensive knowledge in pathogenesis and clinical manifestation of different vascular disorders are essential for phlebologists and vascular surgeons to make a correct diagnosis and choose optimal treatment methods in subjects with a rare pathological entity, such as a post-traumatic AVF.