A Rare Clinical Scenario: Arteriovenous Fistula Secondary to Deep Vein Thrombosis Complicated with Distal Arterial Stenosis

Background: The purpose of this study was to report the successful treatment of a case of arteriovenous fistula secondary to deep vein thrombosis complicated byatherosclerosis of the distal artery, which was a quite rare scenario without consensus for clinical treatment. Case presentation: A 76-year-old woman presented with severe edema and recurrent ulcers in his lower right extremity that had developed for approximately 4 years. His symptoms worsened 2 years ago because of deep vein thrombosis and were not mitigated after the implantation of an inferior vena cava filter followed by standard anticoagulant treatment. Computed tomography (CT) revealed a postthrombotic obstruction of his external iliac veins and a distal arterial stenosis due to atherosclerosis as well as several arteriovenous fistulas between thefemoral vein, femoral artery and their branches. Endovascular recanalization of stenosis and occlusion by balloon dilation resulted in significant improvement of clinical symptoms. Interestingly, arterial patency seems more important than venous patencyin the process of symptomatic relief. Conclusion: Arteriovenous fistula in the lower extremities may develop following deep vein thrombosis and be exacerbated by occlusion or stenosis of the distal artery. Recanalization is a more recommended treatment option according to available data thus far.