case_images: PMC5541807_01
case_images: Right lateral leg venous stasis ulcer.
case_images: CRIVAM2017-9460958.001.jpg
case_images: PMC5541807_01_CRIVAM2017-9460958.001.jpg
case_images: fig1
case_images: A 58-year-old male presented to the emergency department with right lower extremity swelling and a large ulceration on his right lateral leg for nearly six years (Figure 1).
case_images: CT angiogram showing a superficial femoral arteriovenous fistula with arteriomegaly of the right external iliac artery.
case_images: CRIVAM2017-9460958.002.jpg
case_images: PMC5541807_01_CRIVAM2017-9460958.002.jpg
case_images: fig2
case_images: CT angiogram of the abdomen, pelvis, and lower extremities showed right superior femoral arteriovenous fistula and a tortuous right common iliac artery that may be causing a May Thurner's type compression of the R common iliac vein (Figure 2).
case_images: Right lower extremity angiogram showing a patent and enlarged right superficial femoral artery with a distal AV fistula connecting the superficial femoral artery to the femoral vein with venous flow upwards.
case_images: CRIVAM2017-9460958.003.jpg
case_images: PMC5541807_01_CRIVAM2017-9460958.003.jpg
case_images: fig3
case_images: Angiogram revealed a patent but enlarged right common femoral artery, a patent right profunda artery, and a patent and enlarged right superficial femoral artery (SFA) with a distal arteriovenous (AV) fistula connecting the superficial femoral artery to the femoral vein with venous flow upwards (Figure 3).
case_images: Right lower extremity angiogram showing possibility of a venous malformation, which was not seen on previous imaging.
case_images: CRIVAM2017-9460958.004.jpg
case_images: PMC5541807_01_CRIVAM2017-9460958.004.jpg
case_images: fig4
case_images: On pelvic imaging, there also appeared to be very late venous filling possibly of a venous malformation, which was not seen on previous imaging (Figure 4).
case_images: A superficial femoral artery cutdown was performed revealing an enlarged SFA.
case_images: CRIVAM2017-9460958.005.jpg
case_images: PMC5541807_01_CRIVAM2017-9460958.005.jpg
case_images: fig5
case_images: Given concerns that the SFA was so enlarged and at risk for significant hemorrhage, a superficial femoral artery cutdown was performed (Figure 5).
case_images: Superficial femoral arteriovenous fistula occluded after placement of iliac extender stent.
case_images: CRIVAM2017-9460958.006.jpg
case_images: PMC5541807_01_CRIVAM2017-9460958.006.jpg
case_images: fig6
case_images: After postdilation angioplasty there was good apposition against the wall and the fistula filled very slowly via collaterals and not via inline flow (Figure 6).
case_images: Wound healed within 3 months.
case_images: CRIVAM2017-9460958.007.jpg
case_images: PMC5541807_01_CRIVAM2017-9460958.007.jpg
case_images: fig7
case_images: Patient has subsequently undergone Unna booth therapy and the wound has healed completely after 3 months (Figure 7).