ORIGINAL ARTICLE Management of chronic traumatic arteriovenous fistula of the lower extremities K. M. Yousuf • A. R. Bhagwani • N. Bilal Received: 31 October 2012 / Accepted: 21 March 2013 / Published online: 16 April 2013 Ó Springer-Verlag Berlin Heidelberg 2013 Abstract Introduction Vascular injuries secondary to blunt or penetrating trauma are a significant cause of morbidity and mortality, especially in war-afflicted areas. Due to the violent situations of Pakistan and the unavailability of vascular services in remote areas, we are witnessing an increase in the number of delayed/chronic post-traumatic arteriovenous fistulas (AVFs) of the extremities in our institution. The purpose of this study is to share our experience of post-traumatic AVF and the incidence, pre- sentation, and outcomes of these patients. Methods A 10-year retrospective study between January 2002 and May 2012 was conducted. We studied 30 patients with post-traumatic AVF of the lower limbs. Results All 30 cases were due to penetrating injuries, either by gun shots or bomb blasts. All of the patients were treated surgically, except for one patient who was treated with a covered stent. The interval between surgery and presentation ranged from 6 months to 20 years. All patients had complete obliteration of the fistulous tract and there was no recurrence and no post-operative mortality. Conclusion Long-standing traumatic AVF is becoming common in Pakistan. Surgery remains the standard treatment. Keywords Trauma Á Arteriovenous fistula Á Chronic Introduction Vascular injuries secondary to penetrating trauma remains a significant cause of morbidity and mortality in both civilian and military populations. Arteriovenous fistulas (AVFs) are abnormal connections between an artery and a vein which may occur due to trauma or an iatrogenic cause [1]. Trauma partially tears the vessel wall, which disrupts the intima and adjacent muscular layer. This leaves intact the superficial layers of the vessel wall, producing an intimal flap. This flap acts as a source for embolization, as well as a nidus for arterial dissection, occlusion, and development of false traumatic aneurysms and fistula for- mation into the neighboring venous plexuses [2]. Classic clinical manifestations include pain, varicosity, palpable thrill or audible bruit locally, and diminished pulses dis- tally [1]. Men are much more prone to these malforma- tions, as the male sex is more prone towards injury due to exposure [3]. Post-traumatic vascular injuries are common in military services, but critical situations of the Afghan war and occasional violent situations of Pakistan have also disturbed the civilian citizen population. We would like to share our experience of the incidence, presentation, diag- nosis, treatment, and outcomes of these war-affected patients in the past 10-year period. Patients and methods This was a retrospective study on a 10-year period between January 2002 and January 2012 conducted at the Depart- ment of Vascular Surgery, Liaquat National Hospital, Karachi, Pakistan. Only patients with traumatic AVFs of the lower extremities were included in the study. Results We received 30 cases of traumatic AVF (Fig. 1) involving different major vessels. All cases were related to bullet K. M. Yousuf Á A. R. Bhagwani (&) Á N. Bilal Liaquat National Hospital and Medical College, Karachi, Pakistan e-mail: aarian_raw@yahoo.com 123 Eur J Trauma Emerg Surg (2013) 39:393–396 DOI 10.1007/s00068-013-0284-4