Acute and chronic traumatic arteriovenous fistulae in civilians. Epidemiology and treatment.

Traumatic arteriovenous fistula (AVF) is an uncommon form of vascular disruption. We reviewed 70 AVFs in 69 patients. Nearly one in ten acute arterial injuries is an AVF. Only half of these lesions, however, are clinically demonstrable. Iatrogenic lesions were present in 13% of patients. Eighty-one percent of lesions were treated surgically. Extracranial-intracranial (EC-IC) vascular bypass was used in over one third of head and high neck AVFs. Embolization was used as an adjunct to surgery in about one fourth of patients, and fewer than one in ten were treated with embolization alone. Since half of these lesions are not clinically detectable, liberal use of angiography is necessary for all traumatic wounds in proximity to a major vascular structure. Embolization was useful both as a primary treatment of AVF and as an adjunct to surgery; EC-IC bypass facilitates treatment of inaccessible fistulae in the head and neck.