The thrill is gone: Catheter-based exclusion of a posttraumatic arteriovenous fistula with a covered stent graft

Posttraumatic arteriovenous (AV) fistulae of the lower extremities may result from accidental trauma or iatrogenic surgical injuries. Large high-flow fistulae are commonly associated with disabling localized symptoms and impaired wound healing. Therapeutic options are particularly challenging for AV fistulae involving the infrapopliteal circulation. Surgical repair may further delay healing and contribute to greater morbidity. Alternatively, percutaneous coil occlusion in large high-flow fistulae may enable coil embolization to the pulmonary circulation. Using a balloon-expandable covered stent graft, we describe the percutaneous exclusion of a large posttraumatic infrapopliteal AV fistula with immediate clinical symptom improvement and resolution within 3 months following intervention. No clinical symptom recurrence was documented at a 9-month follow-up visit. (c) 2005 Wiley-Liss, Inc.