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Division of Vascular Surgery, Department of Surgery Saint George Hospital University Medical Center University of Balamand, Beirut, Lebanon
Peroneal arteriovenous fistula is a rare condition. Very few cases of traumatic arteriovenous fistula (secondary to military injuries, blunt and penetrating trauma, orthopedic and vascular surgery …) have been reported in the literature. We have observed the case of a non traumatic arteriovenous fistula leading to toe gangrene and non healing wound. A 75 year-old diabetic patient was admitted for severely infected non healing wound of the right foot with osteomyelitis of the second and fourth toes. Doppler study showed a severely decreased flow at the right peroneal artery and no flow at the right dorsalis pedis and posterior tibial arteries. Digital pressure was almost nil. Arteriogram revealed an arteriovenous fistula of the peroneal vessels with apparently a single arteriovenous communication. The foot run off was poor. The patient had no previous history of surgery or trauma. He underwent aorto-coronary bypass for triple vessel disease and then surgical closure of the peroneal fistula with excision of the metatarso-phalangeal articulation of the second and fourth toes. Significant increase of the arterial perfusion of the right foot was observed post-operatively (peroneal arterial pressure: 120 mm Hg, digital pressure: 43 mm Hg). The wound healed three months later. The low flow reported peroneal arteriovenous fistula caused a real steal syndrome which severely decreased the distal peroneal artery flow leading to foot ischemia. This peroneal fistula with its single arteriovenous communication has a congenital origin or is a part of a particular acquired etiologic group. As far as we know, there has been no published observation of such a fistula at the peroneal level causing foot ischemia and toe gangrene.