Traumatic pseudoaneurysm of the superficial femoral artery associated with a spontaneously sealed arteriovenous fistula

Arteriovenous fistulas (AVFs) are abnormal connections between arteries and veins. They may be congenital or acquired through trauma. The most common site for traumatic AVF (TAVF) are the lower limbs, due to the femoral artery being a frequent site of procedures, e.g., femoral catheterization. The closure of these fistulae usually requires surgical intervention and ligation. Rarely, however, these TAVF may undergo spontaneous closure. To the best of our knowledge, no case was reported regarding spontaneous closure of a superficial femoral artery (SFA)-TAVF. A 23-year-old male presented with a one-month history of a right upper thigh swelling which occurred three days following a penetrating bullet injury. On examination, the entry wound was above the swelling and the exit wound was located on the posterior aspect of the right thigh. The popliteal and pedal pulses were absent. The aneurysm was pulsatile. Angiography showed pseudoaneurysm on the SFA. Intraoperatively, the anterior and posterior walls of the SFA were perforated and the anterior wall of the femoral vein was punctured and had a thrombus. The SFA repair was achieved by an inter-positioning autogenous graft. The femoral vein was left untouched. We report this case because of the spontaneously sealed AVF following a thrombus formation on the femoral vein. Usually, TAVF occurs following an acute arterial injury, with penetrating injuries being the most common cause. The management of such presentations is surgical and fistula ligation is advocated. Rarely, TAVF seals spontaneously. In these cases arterial repair with or without venous repair is done.