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Asian Cardiovasc Thorac Ann 2008;16:514
© 2008 Asia Publishing EXchange Ltd

IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY

Rare Presentation of Bilateral Femoral Arteriovenous Fistula

Arvind Kohli, MCh, Gurjit Singh, MCh, Sushil Sharma, DM

Department of Cardio Thoracic and Vascular Surgery, Govt Medical College Jammu, India

For reprint information contact: Arvind Kohli, MCh Tel: 91 191 243 3565 Fax: 91 191 258 4237 Email: drarvind7{at}sancharnet.in, 39B/D, Gandhi Nagar, Jammu Tawi 180004, India.

We present an interesting case of bilateral femoral arteriovenous fistula in a 22 years old male who sustained bullet injury on left side of hip 6 inches below left anterior superior iliac spine the exit wound was on right side superiolateral aspect of thigh. Surprisingly there were no features of hemorrhage from the site of injury. The initial management was in form of local dressings and antibiotics and the patient could walk without difficulty since there was no evidence of bony injury. However, patient presented one month later with features of bilateral limb swelling and discomfort in both the legs on walking. On examination, there was bilateral femoral bruit suggestive of Arteriovenous fistula. Patient was investigated, vascular Doppler study and Aortogram was done which delineated the bilateral femoral Arteriovenous fistula. Interestingly it was more pronounced on the right side than left side (Figure 1Go) with fistula between femoral artery, femoral vein and profunda femoris on right (Figure 2Go) and between femoral artery and vein on left side. Patient underwent staged closure of the Arterivenous fistulas, left side was repaired before right. After taking proximal and distal control, the Arteriovenous fistula was opened from the arterial side and the defect was closed from within and the arteriotomy was repaired using a vein patch.


Figure 1
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  		Figure 1. Arteriogram showing the left femoral arteriovenous fistula between femoral artery and vein.

 

Figure 2
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  		Figure 2. Arteriogram showing the right femoral Arteriovenous fistula involving femoral artery, femoral vein and profunda femoris.

 





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