RESUMO
A unique case of post-traumatic aorto-left renal vein fistula (ALRVF) is presented. Some specific features of diagnosis and treatment of post-traumatic and postaneurysm ALRVF are discussed. The importance of careful planning of the operative strategy is emphasized because substantial blood loss may lead to serious intraoperative complications and frequently necessitates autohemotransfusion. The 10-year follow-up confirmed that direct reconstruction was the appropriate procedure, with no indications that an endovascular procedure would have been preferable. Direct reconstruction may also be valuable in treating postaneurysm ALVRF.
RESUMO
The overall therapeutic strategy in patients with diabetes mellitus and peripheral arterial disease affecting several arterial segments is problematic. Usually, the greater saphenous vein (GSV) is the gold standard for bypass. However, alternative venous grafts may be necessary when the GSV is not available. The superficial veins of the arm are not suitable for bypass operations in most cases because of anatomical variations, inadequate diameter or very thin walls. However, arterialization of the cephalic vein can dilate and strengthen the walls, thus avoiding postoperative complications. The present patient, whose case was followed for 20 months postoperatively, suffered both from diabetes and peripheral arterial disease in a setting of gangrene and a lack of the GSV. The treament of the patient and the problems it incurred are discussed. The advantages of preoperative temporary arteriovenous shunting to improve the quality of the cephalic vein as an alternative autogenous graft are analyzed. Currently, the patient has excellent postoperative results, with healing of the ulcers and preserved peripheral pulses.