Diagnostic and therapeutic approach to complicated arteriovenous fistula

Abstract

Arteriovenous fistula is defined as any abnormal communication between an artery and a vein. This is a rare clinical manifestation of vascular trauma. The use of free flaps has become a fundamental element within the therapeutic arsenal for this disease. The objetive of this article was to present the effectiveness of the flap using the McGregor technique as an alternative therapeutic approach in a case of high clinical complexity. Report the case of a 47-year-old male patient reported, from the age of 15, an increase in volume in the palmar region of the second finger of the right hand. In his health area, he was diagnosed with traumatic arteriovenous fistula. Vascular examination revealed hypertrophy of the second finger of the right hand with dilation of superficial veins at the level of the dorsum, which were pulsatile on palpation. Small ulcerative lesion was observed in the palmar region with active bleeding at manipulation. Embolization was performed twice and up to 50% of vessel occlusion was achieved, but without clinical improvement. It was decided to perform disarticulation of the second finger with flap using McGregor's technique. The release of the flap occurred at 21 days without complications in the surgical procedure and satisfactory evolution. The inguinal flap can be used as a pediculated flap or even as a tubulated flap, with many advantages in the reconstruction of substance losses in the hand or in the distal two-thirds of the forearm, so it represents a useful therapeutic alternative for the management of complex wounds of vascular cause such as complicated arteriovenous fistulas.