Extreme traumatic arteriovenous fistula of the upper limb
This is the case of a traumatic arteriovenous fistula (AVF) with steal syndrome of the upper limb secondary to blunt trauma of the midbrachial artery. A useful technique is herein described involving complete ligation of the fistulous connection with a distal bypass procedure done using reversed Great Saphenous Reversed Vein (GSV) to salvage the upper limb.

Whilst working on a scaffold, a thirty‐two‐year‐old male construction worker fell resulting in trauma to the medial aspect of his arm involving the brachial artery and soft tissues. He was taken to a tertiary referral center where he was resuscitated via the advance trauma life support protocol. There were no other injuries of significance with the exception of an ischemic right upper limb with major injury to the brachial artery.

On exploration, the initial general surgeon found a partially avulsed brachial artery with no nerve or venous injury documented at that time. The vessel was repaired with a vein graft and the limb salvaged.

Postoperatively, there were no palpable distal pulses; however, the limb remained viable. Over the next 6 months, the limb became gradually swollen, painful, and darker in color, with many grossly distended veins. A thrill was present and the limb was mostly nonfunctional during this time.

Source: https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.2399?af=R