Traumatic penetrating arteriovenous fistulas: a collective review

Introduction: Traumatic penetrating arteriovenous fistulas (AVFs) are very rare. The majority of these injuries occur secondary to penetrating trauma. Objectives of this study: review their incidence, clinical presentation, radiologic identification, management, complications and outcomes. Methods: A literature search was performed on MEDLINE Complete-Pubmed from 1829–2019. PRISMA guidelines were utilized. Of 305 potentially eligible articles, 201 articles were selected. Inclusion criteria: patients age ≥ 18, articles with title and abstract in English, AVFs secondary to penetrating trauma, articles which specified vessels involved in AVFs, and those reporting complete information on patient presentation, diagnosis, imaging, surgical and/or endovascular surgical management, and outcomes of penetrating AVF’s. Exclusion criteria: articles reporting blunt or iatrogenic AVFs, pediatric patients, fistulas used for dialysis and their complications, articles lacking complete information, cranial/spinal AVFs or cardiac AVFs, and duplicate articles. Mechanism of injury (MOI), diagnosis, involved vessels, management and outcomes of patients with AVFs secondary to penetrating trauma were recorded. Results: There were a total of 291 patients with AVFs secondary to penetrating injuries. Mechanism of injury (MOI): stab wounds (SW)—126 (43.3%), Gunshot wounds (GSW)—94 (32.3%), miscellaneous—35 (12%), mechanism unspecified—36 (12.4%). Anatomic area: neck—69 (23.7%) patients, thorax—46 (15.8%), abdomen—87 (30%), upper and lower extremities—89 (30.6%). Most commonly involved vessels—vertebral artery—38 (13%), popliteal vein—32 (11.7%). Angiography was diagnostic—265 patients (91.1%). Interventions: Surgical– 202 (59.6%), Endovascular—118 (34.8%). Associated: aneurysms/pseudoaneurysms—129 (44.3%). Conclusion: Most AVFs occur secondary to penetrating injuries. Stab wounds account for the majority of these injuries. Most frequently injured vessels are vertebral artery and superficial femoral vein. Surgical interventions are the most common mode of management followed by endovascular surgical techniques.