Angiol Sosud Khir. 2025 Dec 30;31(4):89-99. doi: 10.33029/1027-6661-2025-31-4-89-99.
ABSTRACT
BACKGROUND: The frequency of injury of the limb major arteries in the era of continuous improvement of firearm types has a pronounced upward trend. There is an increase in the severity of injuries due to changes of damaging agents against the background of the growing number of armed conflicts in the world. Limb injuries occupy a leading position in the structure of war wounds and account for 46 to 74%. The formation of peripheral aneurysms and arteriovenous fistulas (AVFs) is an outcome of vascular trauma in 48.9-68.7% of cases. The lower extremities appear to be the most frequent localization of traumatic arteriovenous fistulas - 17%.
OBJECTIVE: The aim of our study was to evaluate hemodynamic significance of blood flow disorders at local and systemic levels and related clinical manifestations in patients with verified gunshot traumatic limb arteriovenous fistulas depending on localization.
PATIENTS AND METHODS: The study included a total of 102 patients with injuries of the main vessels of the extremities complicated by the formation of traumatic AVFs. All patients with verified traumatic arteriovenous fistulas of the limb, in addition to standard methods of AVF visualization underwent echocardiography in the preoperative period in order to assess the negative influence on the central hemodynamics in the form of right heart overload, to evaluate the presence of pulmonary hypertension. Echocardiography was also performed in the early postoperative period (1-3 days) to assess hemodynamic changes after disconnection of the AVF.
RESULTS: Negative effects on local hemodynamics were instrumentally verified in 100% of cases by ultrasound assessment, as well as by the findings of X-ray contrast methods, with clinical manifestations of limb AVF noted only in 57% of cases. Surgical disconnection of the AVF was followed by statistically significant (p<0.05) changes in the length and volume of the right atrium, pulmonary artery systolic pressure, mean pulmonary artery pressure and right ventricular outflow tract diameter.
CONCLUSION: Traumatic AVFs of the extremities within a period of up to one year from the moment of formation have a negative effect on central hemodynamics when localized on the upper limb only in the region of the axillary artery, when localized on the lower limb - only in the region of the common femoral artery. Traumatic AVFs located more distally have no effect on central hemodynamics during 1 year.
PMID:41805615 | DOI:10.33029/1027-6661-2025-31-4-89-99