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