Traumatic arteriovenous fistula

Penetrating and non-penetrating neck injuries are more likely to damage the carotid than the better protected vertebral artery. The vertebral artery appears to be more vulnerable to rotational and hyperextension injuries of the neck, particularly at the level of the atlas and axis. Laceration, dissection and intimal tears may be complicated by thrombosis and then embolism and, therefore, ischemic stroke at the time of the injury or some days or even weeks after the injury. Later stroke may be a consequence of the formation of a traumatic aneurysm, arteriovenous fistula or a fistula between the carotid and vertebral arteries (Davis and Zimmerman 1983). 

Embolization is also well suited to patients that are initially stable after trauma but develop delayed bleeding over the course of days, weeks, or months [86]. In these patients, the delayed bleeding is most likely due to the formation of a traumatic pseudoaneurysm or arteriovenous fistula, which is more common in patients experiencing penetrating trauma than blunt trauma [95]. Pseudoaneurysms form after blunt trauma due to rapid deceleration-induced injuries to renal arteries [96, 97]. As they form, pseudoaneurysms can contact the collecting system, which can lead to the delayed hematuria often seen in these patients [95]. These pseudoaneurysms can be successfully treated with selective embolization. 

Technical success of embolization for intrarenal vascular injury is quite high, around 95-100% [42-44]. Typically the recurrence rate is nearly 0% however, in one series a second embolization session was needed in 2 (15%) of 13 patients to fully occlude arteriovenous fistulas and achieve true technical success [44]. An analysis of the effect on renal function of selective embolization for traumatic renal lesions revealed that the mean volume of infarcted kidney was only 6% (range 0-15%) and 1 week postembolization the serum creatinine was normal in all their patients [42]. A series of renal transplants estimated that the maximal volume of infarcted kidney after embolization for biopsy-related injuries was always less than 30% [44]. Also, while renal function dete-... 

Tisnado J, Beachley MC, Amendola MA (1979) Transcatheter embolization of traumatic renal arteriovenous fistula. Urol Radiol 1 175-177... 

Helvie MA, Rubin JM (1989) Evaluation of traumatic groin arteriovenous fistulas with duplex Doppler sonography. J Ultrasound Med 16 177-181... 

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