Missed arteriovenous fistulae and false aneurysms in penetrating lower limb trauma: relearning old lessons.

The difficulties in detecting vascular injuries associated with penetrating limb trauma are greater than generally appreciated, and any delay in diagnosis will compromise management and potentially may lead to amputation. Established lessons regarding the mode of presentation and early management of these injuries have to be relearned and are illustrated by three recent case reports of clinically unrecognized lower limb vascular injuries later discovered to be arteriovenous fistulas and false aneurysms. The diagnosis of these lesions may depend on the identification of subtle clinical signs followed by early preoperative angiography, the potential value of which is entirely dependent on the surgeon's acumen and level of awareness.