Arch Hand Microsurg.  2020 Dec;25(4):309-313. 10.12790/ahm.20.0049.

Delayed Arteriovenous Fistula after Reverse Flow Sural Island Flap in Lower Leg: A Case Report

• Byun SJ
• Kang HJ
• Joo MS
• Kim KR

• KMID: 2508946
• DOI: http://doi.org/10.12790/ahm.20.0049

Abstract

Delayed arteriovenous (AV) fistula after soft tissue reconstruction with flap surgery is a rare complication. Here, we describe a case of delayed AV fistula formation after 4 years of reverse flow sural island flap surgery in the lower leg. The patient had swelling, tenderness, and color change to dark purple on previous flap area and foot, similar to cellulitis. Thrill and murmur were observed. AV fistula was formed around the previous vascular pedicle area, as revealed in angiography. We excised the right posterior tibial artery-saphenous vein fistula. The patient is having satisfactory progress since the surgery. We suggest that AV fistula was caused by enhanced angiogenesis and vascular damage.

Keyword

Arteriovenous fistula; Sural flap; Angiogenesis

Figure

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  Fig. 1. (A) Initially open fractures of the tibia and fibula were observed. (B) The fractures showed complete union in the 2 years after the surgery.

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  Fig. 2. After 4 years, the patient visited with swelling, color change, and an ulcer on foot.

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  Fig. 3. Ultrasound examination. (A) Arteriovenous fistula was detected around the previous neurovascular pedicle area. (B) A bruit was detected with the classical machinery-like murmur. (C) It was disappeared when we compressed the proximal lesion (arrow).

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  Fig. 4. Selective angiography. (A) In selective angiography, the posterior tibial artery (arrow) was connected to the small saphenous vein (arrowheads) and formation arteriovenous fistula (asterisk). (B) The small saphenous vein was dilated and its drainage was refluxed into (curved arrow) the veins of the foot with multiple communicating vessels (arrowhead).

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  Fig. 5. In preoperative computed tomography (CT) angiography and immediate postoperative CT angiography, arteriovenous fistula and the small saphenous vein were disappeared and venous dilatation was decreased (A), compared preoperative CT angiography (B). The posterior tibial artery (arrows), the small saphenous vein (arrowhead).

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