High-output heart failure resulting from a traumatic arteriovenous fistula.

A 58-year-old man who received a gunshot wound to the left thigh 40 years previously was admitted to the hospital for investigation of heart failure. At the time of the accident, he had received conservative treatment.Onphysical examination, the patient had fremitus in the left popliteal fossa. Computed tomography showed a significant increase in tortuosity and diameter of the left iliac, femoral, and popliteal arteries due to a large arteriovenous fistula (AVF) located in the popliteal fossa,which also caused increased diameters of the left iliac and femoral veins (A) and an aneurysm of the iliac vein (B; Cover). Through an S-shaped incision in the popliteal fossa, the artery and vein were exposed, separated, and the fistula was closed with 5-0 Prolene sutures. Oral anticoagulationwasmaintained after surgery, and the patient was discharged on the fourth postoperative day in good clinical condition.