Iatrogenic Arteriovenous Fistula After Trans-Heel Traction Pin : A Case Report

Our observation about the appearance of an iatrogenic arteriovenous fistula following the insertion of a trans-heel traction pin is therefore an exceptional event that has never been described before. During the insertion of the pins, the surgeon had damaged posterior tibial artery and vein, giving arteriovenous fistula. The diagnosis of an arteriovenous fistula was entertained because of the vascular peripheric symptomatology on the foot (heat, pain, cyanosis, and trophic disturbances). The diagnosis was possible only with Doppler-duplex and angiography exams. Analysis of this rare event leads us to conclude that, although certainly not particularly risky in terms of the possibility of vascular damage (as shown by the absence of reports in the literature), the positioning of trans-heel, trans-skeletal traction pins should scrupulously adhere to the consolidated technical norms. Otherwise, and as in our case, the combination of a wrong position and direction together with a slight anomaly in the course of the vessels could damage the vascular fascia. Our case confirms the absolute importance of Doppler-duplex and angiography exams for the prompt diagnosis of the AV fistulas. The more adequate surgical management for the AV fistulas is the ligation of the vein and reconstruction of the arterial flow with patch.