Traumatic arteriovenous fistula-A late complication of vascular injuries

Objective: To evaluate the causes, site, duration between the time of injury and presentation and management of traumatic arteriovenous fistula [AVF]

Study Design: A descriptive study

Place and Duration of study: Department of vascular surgery at Combined Military Hospital Rawalpindi from March 2010 to Dec 2011 and Combined Military Hospital Kharian Cantt from Jan 2012 to March 2014

Material and Methods: All the cases of traumatic AVF fistula which reported during this study period were included. Congenital arteriovenous [AV] malformations and fistula for hemodialysis access were excluded from this study. All the cases were evaluated with computerized tomography [CT] angiography or conventional angiography and managed with various open vascular surgical techniques and their results were assessed

Results: Fourteen patients of traumatic AV fistula underwent various open vascular repairs. Age of patients ranged from 16 to 75 years with average age of 34.3 +/- 14.5 years. Male to female ratio was 3.6:1. Penetrating injuries were the commonest cause i.e. 11 [78.6%]. Time interval between injury and presentation in hospital ranged from 4 months to 25 years with average time interval 4.3 years. Lower limb vessels were affected in 10 [71.4%] the upper limb in 1 [7.1%] and neck vessels in 2 [14.3%] and 1 [7.1%] case of post appendectomy AVF between inferior epigastric artery and adjacent vein. Superficial femoral artery and vein was the most frequently involved vessels i.e. 7 [50%] cases

Conclusion: Low velocity penetrating vascular trauma was the commonest cause of traumatic AV fistula. Lower extremities were the most frequently involved site. In most of the cases traumatic AV fistula presents late with its complications. Surgical intervention includes the excision of fistula and restores the continuity of the involved artery and vein with interposition reverse autogenous vein graft or prosthetic graft

Post-traumatic arteriovenous fistula reporting with haematuria after 25 years

A case of post-traumatic arteriovenous fistula in the left thigh is reported 25 years after injury with haematuria. The patient had sustained bullet injury in his left thigh in 1986. Clinically, he had thrill and bruit in his left thigh and groin. Ultrasound abdomen and pelvis revealed a vascular mass in the left side of urinary bladder. CT angiography showed communication between left superficial femoral artery and vein and gross dilatation of thigh and pelvic veins with mass effect on the urinary bladder. He was managed by excision of fistula and repair of both artery and vein with interposition of a prosthetic graft

Embolectomy for acute limb ischemia: experience in 84 cases in a tertiary care hospital

To highlight the presentation, outcome and the role of embolectomy in the management of acute limb ischemia. A descriptive study. Department of Vascular Surgery, CMH Rawalpindi from Oct 2008 to Dec 2010. All patients with acute limb ischemia presenting at CMH Rawalpindi during study period and managed by embolectomy were included. Embolectomy was performed through transfemoral or transbrachial approach, depending upon the limb involved under local anesthesia with Fogarty catheter. Eight four patients of acute limb ischemia were managed by embolectomy during study period. Lower limb was affected more frequently 51 [60.7%] than upper limb 33 [39.3%]. Male to female ratio was 1.4: 1. Forty eight [57.1%] patients reported 12 hours after the onset of symptoms. Embolism was the most common cause present in 53 [63%] and most frequent site of obstruction was femoral bifurcation 23 [45%]. Presence of paralysis and skin changes were bad prognostic signs. Eight patients [9.5%] had fasciotomy at the time of embolectomy. Nine major amputations were carried out in 8 patients [10.7%]. Eleven patients [13.0%] died within 30 days. Limb salvage rate was 83.3%. In the scenario of multiple new therapeutic techniques, embolectomy is still a simple, safe and effective surgical option for treatment of acute limb ischemia

Transverse testicular ectopia

A case of transverse testicular ectopia of the left testis is hereby reported. A 5-year-old boy presented in surgical outpatient department with right inguinal hernia and impalpable testis in left scrotum and inguinal canal. Right herniotomy was performed. Left testis was found in right superficial inguinal pouch and brought to the left scrotum through transceptal window