Correção cirúrgica de fístula arteriovenosa traumática em artéria femoral comum esquerda e impacto do uso de anticoagulação oral no seguimento ambulatorial: relato de caso

Abstract

Traumatic arteriovenous fistulas are abnormal communications between the arterial and venous systems, usually caused by penetrating trauma, and may lead to significant local and systemic repercussions. Delayed diagnosis is associated with chronic venous insufficiency, edema, varicose veins, ulcerations, and high-output cardiac overload. Definitive treatment is surgical or endovascular, depending on anatomical and clinical conditions. We report the case of a 42-year-old male patient who sustained a gunshot wound to the left groin and developed progressive edema, varicose veins, and difficult-to-heal ulcers over 18 months. Imaging studies revealed a high-flow arteriovenous fistula between the left common femoral artery and vein. The patient underwent open surgical repair with direct fistula closure. Postoperatively, proximal venous occlusion was detected, and oral anticoagulation with rivaroxaban was initiated for three months, associated with elastic compression. The patient showed favorable clinical evolution, with progressive reduction of edema, complete healing of skin lesions, and absence of deep venous thrombosis on follow-up. This case highlights the importance of early diagnosis, appropriate surgical repair, and individualized use of anticoagulation in traumatic arteriovenous fistulas.