Acute and chronic traumatic arteriovenous fistulae in civilians. Epidemiology and treatment
K. R. Kollmeyer, J. L. Hunt, B. A. Ellman and W. J. Fry
Traumatic arteriovenous fistula (AVF) is an uncommon form of vascular
disruption. We reviewed 70 AVFs in 69 patients. Nearly one in ten acute
arterial injuries is an AVF. Only half of these lesions, however, are
clinically demonstrable. Iatrogenic lesions were present in 13% of
patients. Eighty-one percent of lesions were treated surgically.
Extracranial-intracranial (EC-IC) vascular bypass was used in over one
third of head and high neck AVFs. Embolization was used as an adjunct to
surgery in about one fourth of patients, and fewer than one in ten were
treated with embolization alone. Since half of these lesions are not
clinically detectable, liberal use of angiography is necessary for all
traumatic wounds in proximity to a major vascular structure. Embolization
was useful both as a primary treatment of AVF and as an adjunct to surgery;
EC-IC bypass facilitates treatment of inaccessible fistulae in the head and
neck.
