Delayed Diagnosis of a Traumatic Popliteal Arteriovenous Fistula After 54 Years: Case Report, Surgical Management, and Literature Review.

Objective: Traumatic popliteal arteriovenous fistulas are rare vascular disorders, usually resulting from penetrating injuries. Most cases become symptomatic within a few months; however, exceptionally long latency periods have been reported, usually spanning two to three decades. This report describes a case of a traumatic popliteal arteriovenous fistula caused by penetrating trauma to the popliteal region during childhood with an extraordinary latency of 54 years before the onset of symptoms. Diagnostic and therapeutic approaches and a literature review are discussed in the context of this rare presentation. Methods: A 61 year old woman presented to the hospital's outpatient clinic with progressive pain, venous hypertension in the left lower limb, and exertional dyspnoea, which had become evident over the past 6 months. Physical examination revealed left leg oedema with significant lymphovenous stasis, diminished tibial pulses, and a palpable pulsatile mass in the popliteal fossa, accompanied by a systolic bruit-findings suggestive of an arteriovenous fistula. Initially, the patient did not recall any recent trauma or associate her symptoms with a past injury. However, a detailed medical history revealed a penetrating injury to the popliteal region sustained at the age of 7 years. Doppler ultrasound and computed tomography angiography confirmed a high flow popliteal arteriovenous fistula with venous dilation. Results: Following a thorough evaluation, surgical repair was preferred over endovascular intervention due to the complex anatomical characteristics and location of the fistula. After surgery, the patient experienced complete resolution of symptoms. Conclusions: This case demonstrates that traumatic popliteal arteriovenous fistulas can have an exceptionally prolonged latency period, emphasising the need for clinical vigilance and comprehensive diagnostic imaging, even in patients with a remote history of trauma. Although endovascular treatments are increasingly favoured, open surgical repair remains a crucial and effective option for particularly complex post-traumatic popliteal arteriovenous fistulas.