Late arteriovenous fistulas and pseudoaneurysms of the extremity secondary to civilian firearms.

To evaluate the treatment of late sequelae of penetrating arterial injuries associated with civilian firearms, such as false aneurysms and arteriovenous fistulas (AV-Fs) of the extremities, a retrospective clinical study was carried out. Whenever diagnosis or operative management is delayed because of local fibrosis or morphological and structural vessel changes, primary repair is not feasible and segmental resection is required. Twenty-four patients presenting late false aneurysms (14) and AV-Fs (11) of the extremities, caused by firearms (6 rifle wounds, and 18 pistol wounds), were identified between 1983 and 1995. Twenty-three patients were submitted to resection of pseudoaneurysms (13) or AV-Fs (8), while arterial patch angioplasty was applied in two patients. The venous lesions were repaired by an interposition graft (7) or lateral venorraphy (3). Saphenous vein (15) or PTFE (6) grafts were placed in injured arteries. Percutaneous embolization by coils was performed in two patients. Twenty-three out of 24 patients (95.8%) recovered; one patient (4.1%), affected by aneurysmal AV-Fs of a lower limb dating from 12 years, with enlarged and weakened artery, bled to death. No limb loss occurred. A better evaluation of minimal vascular injuries is required to avoid late sequelae of civilian firearms lesions, with significant blood loss, which need segmental excision of the injured vessels.