This was a 42-year-old male who underwent surgery for transposition of the great arteries as a child. Twenty years later a catheterization through the right deep femoral artery was performed. Over the last five years he has had edema with a change in color of his right foot 50 seconds after going from a lying to a standing position (Figure 1). Computed tomography angiography corroborated the diagnosis of an arteriovenous fistula (AVF) in the right femoral system (Figures 2 and 3). He was referred to vas cular surgery for stent placement.

Figure 1
Sequential clinical images (A, B, C and D) of a 42-year-old male who had edema in the pelvic portion of the right lower extremity along with changes from a normal to a purplish color in the right ankle and foot over a span of 50 seconds.

Figure 2
(A): an axial view of an iliofemoral computed tomography angiography of the connection between the anterior wall of the deep femoral artery and a blind venous sac connecting to the femoral vein. Note the mix of contrast in the venous territory in an arterial phase; (B): volumetric reconstruction of the iliofemoral computed tomography angiography in the venous phase, showing pre-pubic and right proximal thigh varicose bundles stemming from venous insufficiency driven by deep vein thrombosis.

Figure 3
Volumetric reconstruction of the iliofemoral computed tomography angiography (A): frontal plane; (B): sagittal plane. The arrow indicates the ante rior wall of the proximal third of the deep femoral artery, as well as a blind venous sac draining to the femoral vein, with aneurysmal dilation of the iliac vein.

Diagnostic and therapeutic percutaneous catheterization techniques entail a risk of vascular complications such as AVF, false aneurysms, hematomas, hemorrhages and arterial thromboses, with an incidence of 0.5% to 1% after diagnostic procedures; 0.0-9% after balloon angioplasty; 5.7-17% after stent implantation and 5.2-10% after percu taneous mitral vavuloplasty ^1,2. Covered stents are used to resolve the AVFs ³.

References

Alonso M, Tascón J, Hernández F, Andrue J, et al. Complicaciones del acceso femoral en el cateterismo cardíaco: impacto de la angiografía femoral sistemática previa y la hemostasia con tapón de colágeno VasoSeal-ES. Rev Esp Cardiol 2003; 56: (6) 569-577. DOI: 10.1157/13048154.

Maynar J, López ZF, Castaño S, Iturbe M, Barrasa H, et al. Catéteres de arteria y de vena femoral: complicaciones relacionadas con su inserción y alter nativas técnicas para evitarlas. Medintensiva 2013; 37: 369-371. DOI: 10.1016/j.medin.2013.03.010.

Alvarado AL, Romero CJ, López HC, Peralta LJ. Manejo endovascular de fístula arteriovenosa postraumática. Rev Sanid Mil. 2018; 72: 351-354.

Author notes

^* Correspondencia: Dr. Luis Gerardo Domínguez Carrillo. Guanajuato (México). E-Mail: lgdomínguez@hotmail.com