Posttraumatic popliteal pseudoaneurysm associated with arteriovenous fistula – case report and literature review

Introduction: Lower limb vascular injuries secondary to penetrating or blunt traumas can cause the formation of arteriovenous fistula with serious immediate complications (e.g. limb ischemia, amputation) or late complications (e.g. pseudoaneurysms, congestive heart failure). Pseudoaneurysms are pseudo tumoral formations, made up of a wall of conjunctive tissue, with or without endothelium, the other structural elements of the arterial wall being absent. Early diagnosis and the surgical treatment of pseudoaneurysm is imperious with the purpose of minimizing the morbidity rate. Case presentation: We describe a 25-year-old male patient which presented at admission varicose veins and oedema of left limb with a pulsatile mass in the popliteal region, with a scar at this level, following a puncture penetrating wound trauma 2 years ago. The patient's history and physical examination raised the suspicion of an arteriovenous fistula with a popliteal pseudoaneurysm, but the final diagnosis was determined after performing Duplex imaging and angiography. Surgical treatment consisted of eradicating the arteriovenous.communication with restoring popliteal arterial and venous vascular continuity. There were no intra or postoperative complications and the evolution was uneventful.Conclusions: Duplex imaging together with arteriography or CT angiography should be considered for every patient with a puncture penetrating wound in the proximity of large vessels. In the present case, the arteriovenous fistula was not diagnosed immediately post-trauma, and the patient subsequently presented for examination with symptoms of chronic venous insufficiency. Therefore, both vascular imaging and clinical examination are of great importance in detecting the arteriovenous fistula and the late complication, the pseudoaneurysm.