Traumatic arteriovenous fistula after ice axe injury 27 years ago: A case report

We report a case of a traumatic arteriovenous fistula (AVF) between the superficial femoral artery and femoral vein that went undetected for 27 years following an ice axe injury during a climbing accident in 1997. An AVF is an abnormal connection between an artery and a vein, where blood flows directly from the high-flow arterial system to the low-flow venous system, bypassing the capillaries. A 74-year-old male presented with a 2-year history of extensive left leg swelling. He had visible posterior thigh and calf varicose veins and a small scar to the left medial upper thigh. He was otherwise fit and hiking regularly. He also had mild left ventricular and severe bi-atrial dilation, with high output cardiac failure and cardiac remodelling. With ultrasound, a traumatic AVF between the superficial femoral artery and femoral vein was identified. We also assessed the arterial vasodilatory function in both femoral arteries for a within-subject comparison of the chronic effects of high shear stress - the result of high flows through the AVF. This case study discusses the imaging and physiological test findings, along with further details of the climbing accident which were revealed by the patient. Traumatic AVFs are uncommon, and to our knowledge, this is the first documented case of an AVF resulting from an ice axe injury. Almost three decades later, the moment on the mountain left its mark; this case illustrates the complications associated with an untreated AVF.