Diagnostic algorithm and surgical treatment for traumatic arteriovenous fistulas of extremities

OBJECTIVE: To develop an optimal diagnostic and treatment algorithm for patients with vascular injuries and suspected gunshot traumatic arteriovenous fistulas (AVF) of limbs. MATERIAL AND METHODS: There were 102 patients with injuries of great vessels of extremities complicated by traumatic AVFs. We observed 55 cases of isolated traumatic AVF and 47 cases of traumatic AVF with false aneurysm. We evaluated verification rate of traumatic AVFs by ultrasound specialists who performed routine scanning (daily) and those who used ultrasound in fast-protocol format. We analyzed the causes of diagnostic omissions at the stage of primary diagnosis. Necessary diagnostic measures depending on localization of traumatic AVF were determined. Algorithm of traumatic AVF treatment was developed. RESULTS: Original diagnostic and treatment algorithm based on topographic localization of traumatic AVF and posttraumatic false aneurysm considers prognosis of limb movements and function, as well as allows to choose optimal diagnostic strategy, type and extent of surgical intervention. CONCLUSION: Small incidence of this pathology often does not allow different specialists to detect, recognize and refer such patients to special hospitals in timely manner. Moreover, there are no clear diagnostic algorithms and methods for choosing surgical intervention.