An Atypical Presentation of Vascular Injury in Extremity Trauma Beyond Current Guidelines

CT angiography (CTA) is a key diagnostic tool for evaluating vascular injuries in trauma patients. Current guidelines from the Eastern Association for the Surgery of Trauma (EAST) recommend CTA when there are abnormal physical findings or an ankle-brachial index (ABI) ≤ 0.9. We present the case of a 32-year-old male with a gunshot wound to the thigh who had a normal ABI and did not meet the established criteria for imaging. However, CTA was performed due to subtle signs, including distal limb swelling, and revealed a traumatic femoral arteriovenous fistula. The patient subsequently underwent successful endovascular repair. This case highlights the limitations of existing guidelines and underscores the continued importance of a thorough physical examination, a high index of suspicion, and sound clinical judgment.