PMC6440509_01
Baseline US using a linear Doppler 6-12 MHz transducer. A.
Low-resistance, single-phase blood flow spectrum in the popliteal artery, indicating blood supply to a high-flow fistula. B.
Arteriovenous fistula in the anterior tibial vessels. C.
Fistula and dilated efferent vein in both B-mode and Doppler ultrasound
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A and B). An arteriovenous fistula at the site of anterior tibial artery damage and a dilated efferent vein of the AVF were identified in the region of lower leg injury (Fig. 1 C).
Arteriography showing an arteriovenous fistula in the lower leg. A.
Preliminary arteriography confirming the presence of posttraumatic arteriovenous fistula and a piece of metal responsible for arterial damage near the anterior tibial artery. B.
Rapid venous blood outflow from the fistula, evident dilation of the efferent AVF veins
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Preliminary arteriography revealed an arteriovenous fistula, while fluoroscopic images of this region showed a piece of metal responsible for vascular damage (Fig. 2).
Embolization of arteriovenous fistula of the lower leg. A.
Implantation of Amplatzer vascular occluder in the fistula. A visible piece of metal responsible for anterior tibial artery damage. B.
Blood supply to the fistula through collateral circulation from peripheral arterial segment. C.
Injection of Glubran 50% mixture through a direct puncture
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The artery was closed at the site of fistula, however, a follow-up arteriography showed minor, yet evident, blood flow into the fistula from the peripheral arterial segment through collateral circulation (Figs. 3 A and B). In the next stage of treatment, a mixture of cyanoacrylate glue and Lipiodol (Glubran 50%) was injected through a direct puncture during efferent vein compression, which led to complete fistula closure (Fig. 3 C).
Ultrasound assessment of endovascular treatment efficacy. A.
Amplatzer vascular occluder implanted into the arteriovenous fistula in B-mode presentation. B.
Closure of the arteriovenous fistula in the lower limb. C.
Normal blood flow in the popliteal artery and vein
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Complete closure of fistula as well as normal blood flow in the popliteal artery and vein were confirmed (Fig. 4).