Case Description
A 75-year-old male presented with an immediately threatened grade IIb
acute ischemia of the left leg due to thrombosis of a
femoro-infrapopliteal prosthetic bypass graft. After an urgent Computed
Tomography Angiography, an urgent graft thrombectomy was performed using
a 5 Fr Fogarty catheter, which had a troublesome distal passage. The leg
recovered normal motor and sensory function. Surprisingly, a hand-held
Doppler device obtained a continuous machinery bruit in the anterior
tibial artery/veins suggesting an arteriovenous fistula, which was
depicted in a subsequent Digital Subtraction Angiography and a color
duplex exam (S1). Most likely, the Fogarty catheter had unintentionally
perforated the anterior tibial artery passing into one of the adjacent
anterior tibial veins [1-2]. Patient was managed conservatively and
the arteriovenous fistula was found to be spontaneously thrombosed in a
three-month follow-up (S1).
Keywords: Iatrogenic injury, Fogarty thrombectomy, graft
thrombectomy, arteriovenous fistula