PMC5541807_01
Right lateral leg venous stasis ulcer.
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A 58-year-old male presented to the emergency department with right lower extremity swelling and a large ulceration on his right lateral leg for nearly six years (Figure 1).
CT angiogram showing a superficial femoral arteriovenous fistula with arteriomegaly of the right external iliac artery.
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CT angiogram of the abdomen, pelvis, and lower extremities showed right superior femoral arteriovenous fistula and a tortuous right common iliac artery that may be causing a May Thurner's type compression of the R common iliac vein (Figure 2).
Right lower extremity angiogram showing a patent and enlarged right superficial femoral artery with a distal AV fistula connecting the superficial femoral artery to the femoral vein with venous flow upwards.
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Angiogram revealed a patent but enlarged right common femoral artery, a patent right profunda artery, and a patent and enlarged right superficial femoral artery (SFA) with a distal arteriovenous (AV) fistula connecting the superficial femoral artery to the femoral vein with venous flow upwards (Figure 3).
Right lower extremity angiogram showing possibility of a venous malformation, which was not seen on previous imaging.
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On pelvic imaging, there also appeared to be very late venous filling possibly of a venous malformation, which was not seen on previous imaging (Figure 4).
A superficial femoral artery cutdown was performed revealing an enlarged SFA.
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Given concerns that the SFA was so enlarged and at risk for significant hemorrhage, a superficial femoral artery cutdown was performed (Figure 5).
Superficial femoral arteriovenous fistula occluded after placement of iliac extender stent.
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After postdilation angioplasty there was good apposition against the wall and the fistula filled very slowly via collaterals and not via inline flow (Figure 6).
Wound healed within 3 months.
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Patient has subsequently undergone Unna booth therapy and the wound has healed completely after 3 months (Figure 7).