Volume 49, Issue 3 Fall 2025 JVU 493-149 | Idiopathic Popliteal Arteriovenous Fistula: Presentation, Diagnosis, and Management-Idiopathic Popliteal Arteriovenous Fistula

Idiopathic Popliteal Arteriovenous Fistula

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This 2025 case report published in the Journal for Vascular Ultrasound describes a rare idiopathic (nontraumatic, likely congenital) arteriovenous fistula (AVF) between the popliteal artery and vein in a 79-year-old woman. The patient presented with an 18-month history of mild left leg pain, swelling, and heaviness on walking. Initial ultrasound and CT angiography revealed a large popliteal AVF with arterial ectasia, but no immediate treatment was pursued. On subsequent presentation with persistent symptoms, duplex ultrasound showed high-flow AVF with a flow rate of 1300 mL/min in the affected leg compared to 159 mL/min on the contralateral side, along with a 2 cm leg-length discrepancy—suggesting a congenital etiology.<br /><br />The AVF was successfully treated using an endovascular approach involving deployment of two overlapping 9-mm self-expanding stent grafts (Viabahn) across the fistula. Intravascular ultrasound (IVUS) aided precise localization of the fistula site and artery sizing. Post-procedural duplex imaging at 4 weeks demonstrated normalization of arterial flow to 180 mL/min and resolution of venous arterialization. The patient's symptoms of leg pain and swelling resolved completely.<br /><br />The report highlights that lower extremity AVFs are uncommon and usually result from trauma or surgery, with idiopathic popliteal AVFs extremely rare. AVFs manifest clinically with venous hypertension symptoms due to arterialized venous flow and may lead to complications like ulceration or high-output cardiac failure if untreated. Duplex ultrasonography is the preferred noninvasive diagnostic tool. Treatment options include open surgical repair and various endovascular techniques such as stent grafts, coiling, embolization, or plugs. Endovascular repair is favored for being less invasive and associated with fewer complications, though patency may be inferior to open repair long term.<br /><br />This case demonstrates successful diagnosis and management of a congenital popliteal AVF using modern endovascular methods, supporting duplex imaging and IVUS as critical tools for treatment planning and post-intervention monitoring. The authors advocate consideration of endovascular exclusion for symptomatic high-flow AVFs in the popliteal region.

Keywords

idiopathic arteriovenous fistula

popliteal artery

popliteal vein

endovascular stent graft

duplex ultrasonography

intravascular ultrasound

congenital AVF

high-flow AVF

vascular ultrasound case report

leg pain and swelling