Volume 50, Issue 2 Summer 2026 JVU 502-75 | Acquired Arterio-Venous Fistula Following Deep Vein Thrombosis-Acquired Arterio-Venous

Acquired Arterio-Venous

Pdf Summary

This case report describes an unusual acquired arteriovenous fistula (AVF) discovered after deep vein thrombosis (DVT) in a 78-year-old man. He initially had an acute, extensive left-leg DVT in 2022, which later evolved into chronic post-thrombotic symptoms including swelling and pain. On follow-up ultrasound in 2023, the thrombus still extended through the popliteal, femoral, and iliac veins, with signs of chronic recanalisation suggesting post-thrombotic syndrome (PTS). However, Doppler imaging revealed unexpected pulsatile, arterialised venous flow. Further scanning identified a connection between the common femoral artery and the sapheno-femoral junction, consistent with an AVF.<br /><br />The patient had no history of groin access, surgery, or trauma, making the AVF unlikely to be iatrogenic or congenital. He was treated conservatively with anticoagulation (apixaban), and his symptoms improved without intervention.<br /><br />The authors review prior reports showing that AVFs can occur after DVT, though they are rare and may be missed when symptoms are attributed to PTS alone. Some symptomatic patients improved after venous stenting, while asymptomatic patients were managed with observation. A retrospective study suggested venous hypertension-relieving therapies, especially stenting, may outperform compression alone in selected patients.<br /><br />The paper proposes a possible mechanism involving hypoxia-driven angiogenesis. Chronic venous occlusion may upregulate HIF-1 and VEGF-A, promoting abnormal new vessel formation and potentially contributing to AVF development.<br /><br />The main message is that vascular ultrasound, especially spectral Doppler in addition to compression and color Doppler, is essential for detecting AVF in patients with prior DVT and chronic leg symptoms.

Keywords

arteriovenous fistula

deep vein thrombosis

post-thrombotic syndrome

Doppler ultrasound

arterialised venous flow

chronic venous occlusion

venous hypertension

venous stenting

hypoxia-driven angiogenesis

vascular ultrasound