PMC7586047_01
A: Image showing swelling, varicosities and leg venous ulcer. B: CT angiography (3D) showing a femoral fistula with very enlarged veins. C: CT angiography showing the dilated veins, Note the dilation of the iliac vein (black arrow). D: arteriography image showing the femoral fistula (direct communication between femoral vessels with venous opacification in the arterial phase). E: per-operative image after dissectingdemonstrating the fistula and the vessel defect.
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An 18 year-old male patient with no medical history or drug consummation, was stabbed 4 years ago in his left mid-posterior thigh and now suffering from a chronic venous ulcer on his left leg with varicose veins and swelling (Fig. 1A). AVF between the superficial femoral artery and the femoral vein, with an important dilatation of the artery proximal to the fistula and the veins proximally and distally (Fig. 1B, C). A selective arteriography showed with precision the fistula located at the mid-thigh (Fig. 1D). A surgical intervention was undertaken, we performed a direct approach, the dissection found a very large fistula (2 cm) with enlarged artery and vein (Fig. 1E), that we repaired with a running sutures.
PMC7586047_02
A: CT angiography (3D) showing a femoral fistula with a short popliteal occlusion. B: arteriography image showing the femoro-femoral fistula black arrow and the popliteal occlusion. C: arteriography image showing the results after angioplasty of the popliteal artery and the placement of the stent-graft covering the fistula.
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CT angiography showed a femoro-femoral AVF with a chronic popliteal artery occlusion (Fig. 2A). The patient was admitted to the operating room where we performed a selective angiography that helped locating the AVF and evaluating the popliteal occlusion (Fig. 2B), an 8 mm x 40 mm stent graft was deployed to cover the AVF and the occlusion was treated by balloon angioplasty successfully (Fig. 2C).
PMC7586047_03
A: Image showing limb swelling and the tumefaction due to the pseudoaneurysm. B: CT angiography showing the pseudoaneurysm. C: CT angiography showing the dilated femoral vessels. D: Arteriography image showing the pseudoaneurysm. E: Arteriography image showing the results after stent-graft placement covering the fistula. F: per-operatory image showing the pseudoaneurysm resection by a mini-invasive surgery after endovascular.
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A 27 year-old male, with no medical history or drug consummation, who was stabbed 2 months ago in his left lower-anterior thigh, complaining from swelling and pain in his left limb, a pulsatil masse at his thigh (Fig. 3A) and exertional dyspnea. CT angiography showed the popliteal pseudoaneurysm (10 x 6 cm) (Fig. 3B) associated to the AVF with very dilated artery (17 mm) and veins (Fig. 3C). We treated the patient by endovascular technique first (Fig. 3E, F), placing a stent graft, Cheatham Platinum (CP) Stent System (18 mm x 45 mm) and we performed a mini-invasive surgery to remove the compressive pseudoaneurysm (Fig. 3D).
PMC7586047_04
A: Pre-operatory image showing skin erosion caused by the pseudoaneurysm and the swelling at the right thigh. B: CT angiography (3D) showing the pseudoaneurysm and the femoral AVF. C: per-operatory images after evacuating the pseudoaneurysm showing the femoral AVF. D: per-operatory image showing the results after repairing the superifical artery with a venous graft and the femoral vein.
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Clinical examination found a pulsatil masse with a continuous thrill and inflammatory signs at the skin that showed early signs of impending rupture (Fig. 4A). CT angiography revealed a pseudoaneurysm of the superficial femoral artery with a femoro-femoral AVF (Fig. 4B). The patient was admitted urgently to the operating room where we performed a surgical repair of the artery, after removing the pseudoaneurysm, with a venous graft and we repaired the vein with running sutures (Fig. 4C, D).