Acquired Traumatic Arteriovenous Fistula of the Long Finger

Acquired posttraumatic arteriovenous fistula (AVF) of the distal upper limb is extremely rare compared with congenital lesions, and in the finger is even more uncommon.

A 29-year-old man was referred with a gradually enlarging and disfigurative swelling in his right long finger centered at the middle phalanx level, with a preceding history of previous blunt trauma ([Fig. 1A]). This was associated with a palpable thrill, pain, heaviness, and cold intolerance. Doppler ultrasonography showed a vascular ball with tortuous vessels and a low-resistance flow, suggesting an AVF ([Fig. 1B]).

Fig. 1 (A) Acquired posttraumatic arteriovenous fistula (AVF) of the long finger presented as a gradually enlarging and disfigurative swelling centered at the middle phalanx level. (B) Doppler ultrasonography showed a vascular ball with tortuous vessels and a low-resistance flow, suggesting an AVF. (C) A longitudinal incision was made in the radial side of the finger. The feeding vessel was carefully identified and was then ligated.

Operative intervention was offered because it was enlarging and was becoming symptomatic. Under general anesthetic, a longitudinal incision was made in the radial side of the finger. The feeding vessel was carefully identified and was then ligated ([Fig. 1C]). Total operative time was 45 minutes, and there was minimal blood loss. He was discharged the next day after an uncomplicated recovery.

Histopathology confirmed an arterialized vein consistent with the diagnosis of traumatic AVF, with 4 × 1 × 0.4 cm. Follow-up revaluation after 1 month showed complete resolution of his symptoms.

Posttraumatic AVF of the finger should be considered as a differential diagnosis when there is a persistent palpable and pulsatile lesion after the traumatic swelling has resolved. Complete surgical excision with ligation of the main feeding artery is effective and prevents complications.