Resolution of a femoral arteriovenous fistula secondary to chronic Iliac vein occlusion after stenting: a case report

Acquired femoral arteriovenous fistula (FAVF) secondary to chronic iliac vein occlusion is rare and often underdiagnosed. The optimal management remains controversial. An 80-year-old woman presented with progressive left lower extremity swelling for two months. Imaging revealed chronic left iliac vein occlusion and an incidental femoral arteriovenous fistula, presumed to be secondary to venous hypertension. The patient underwent endovascular recanalization via the contralateral femoral artery and ipsilateral popliteal vein access, with placement of two self-expanding stents from the common iliac to mid-femoral vein. Postoperative imaging confirmed stent patency and complete resolution of the arteriovenous shunt. The inferior vena cava (IVC) filter was successfully removed 20 days after the procedure. Isolated iliac vein stenting can effectively resolve secondary FAVF by restoring venous outflow and reducing venous pressure. This minimally invasive strategy should be considered first-line therapy in patients with obstructive venous disease and concomitant FAVF.