Original article Chronic ischaemic leg ulcer as a late complication of post-traumatic arteriovenous fistula S Suknaic*, L Erdelez*, A Skopljanac † , D Sef* and K Novac ˇic ´ ‡ *Department of Vascular Surgery, University Hospital ‘Merkur’, Zajceva 19, Zagreb 10 000; † Department of Cardiovascular Surgery, Special Hospital for Cardiovascular Surgery and Cardiology ‘Magdalena’, Krapinske Toplice; ‡ Department of Diagnostic and Interventional Radiology, University Hospital ‘Merkur’, Zagreb, Croatia Abstract Objective: Chronic post-traumatic arteriovenous fistula (AVF) is a late complication of vascular injury and can be presented with symptoms of congestive heart failure, venous hypertension and distal ischaemia. We present an unusual case of chronic ischaemic leg ulcer in young adult caused by post-traumatic AVF. Case report: A 29-year-old male patient was admitted to our hospital with symptoms of chronic ulcer located on the lateral side of the lower left leg. Arterial pulses distally from the groin were absent. His medical history revealed him to have sustained gunshot injury of the left thigh in the war conflict 18 years before. Angiography showed a large AVF between superficial femoral artery and femoral vein. The patient underwent surgical repair of AVF with reconstruction of superficial femoral artery by saphenous vein interposition under spinal anaesthesia. Completion angiography confirmed AVF exclusion. Leg ulcer healed within a month. Conclusion: Chronic leg ulcer may be the only symptom of large post-traumatic AVF in young adults. Keywords: arteriovenous fistula; trauma; ischaemic leg ulcer; surgery Introduction Post-traumatic arteriovenous fistula (AVF) may be a complication of stab wound, blunt trauma, gunshot injury or even fracture. Most often it occurs after medical interventions or diagnostic procedures such as angiography or surgical interventions that have caused inadvertent trauma to the artery and vein. 1 Clinical symptoms depend on the size and location of AVF. Small AVFs located on extremities are usually asymptomatic and are identified acci- dentally. 1,2 Larger AVFs present with prominent superficial veins, oedema of a limb or, in the case of larger communication between artery and vein, with the symptoms of congestive heart failure. 3 Large AVF can produce symptoms of distal ischaemia and present like symptomatic peripheral artery disease. We present history, clinical findings, diagnosis and successful treatment of chronic ischaemic leg ulcer as a complication of post- traumatic AVF in a young adult. Case report A 29-year-old male patient was admitted to our hospital with the symptoms of chronic ulcer located on the lateral side of left lower leg (Figure 1). The ulcer developed after minor acciden- tal scratch six months before admission. Arterial pulses were absent distally from the groin. Left foot was colder than the right one. Scars from the old penetrating gunshot wound were found on the medial and contralateral side of the left thigh. Over the scar on the medial side of the thigh, audible murmur and palpable thrill were detected. The patient’s medical history revealed him to have sustained a high-velocity gunshot injury of the left thigh at age 11 during the war in Croatia. He was operated on; however, no medical documentation Correspondence: D Sef MD. Email: davorin.sef@gmail.com Accepted 4 April 2011 Phlebology 2012;27:124–127. DOI: 10.1258/phleb.2011.011018