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An Infrequent Complication of Arteriovenous Fistula

Henry J. Schmitt Jr., USAF (MC); George L. B. Grinnan, USAF (MC)
Arch Surg. 1968;96(5):829-831. doi:10.1001/archsurg.1968.01330230137020.
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ARTERIOVENOUS fistulae in the war wounded are frequently overlooked. The oversight often stems from attention to more serious injury. An early asymptomatic state of most of these lesions also contributes to their remaining undetected. Elkin and Shumacker,1 in writing on arteriovenous fistula in World War II casualties, recommended that every wound be examined from the standpoint of possible vascular injury and that auscultation of the wound be routinely included in the examination.

The recommended treatment, once the diagnosis is made, is resection of the fistula with anastomosis or lateral repair of the artery. Venous repair, rather than ligation is also recommended if a major vein is involved. Fistulae between minor vessels may be treated by ligation and excision.2 When the fistula produces cardiac failure or vascular insufficiency of an extremity, the need for correction becomes more urgent. The following case exemplifies a less common complication of arteriovenous fistula


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