High-Output Heart Failure Secondary to Post-Traumatic Arteriovenous Fistula

Abstract

Introduction: Arteriovenous fistulas are abnormal connections between the arterial and venous systems that bypass normal anatomical capillary beds. Any device, implement, or projectile that passes through an artery and vein has the potential to lead to one, thereby preventing normal blood flow through the capillary bed. Late complications of untreated arteriovenous fistulas include proximal arterial dilation, venous congestion, congestive heart failure, and distal ischemia. Objective: Describe the clinical manifestations, diagnostic, therapeutic, prognostic complexities and complications present in post-traumatic arteriovenous fistula and its association with heart failure. Material and methods: Retrospective study presentation of a clinical case. Results: The case of a 55-year-old female patient is presented, with a 2-year history of ischemic heart disease and a gunshot wound 20 years ago. Who was admitted for bypass and coronary angiography + cardiac angiography in whom no etiology of his dilated ischemic heart disease was found until Doppler ultrasound and tomography angiography was performed due to recurrence of pain in the lower limbs and changes in skin color, which revealed presence of arteriovenous fistula. The same one that was resolved with distal ligation of the popliteal vein + exclusion of aneurysm. Conclusions: Risk factors for the development of this pathology are difficult to establish. Therefore, the shotgun trauma to the left leg 20 years ago, in addition to her obesity and female sex, led to the formation of an arteriovenous fistula that would gradually produce high-grade heart failure. Endovascular AVF repair is a treatment alternative for those patients considered high risk from anesthesia, those who have a hostile groin due to excessive scar tissue, or who cannot tolerate the consequences of bleeding that can occur with surgical control. of the FAV.