2021 年 2 巻 1 号 p. 27-31
Arteriovenous fistulas in the lower limbs are usually caused by trauma or surgical intervention and may sometimes be congenital. Furthermore, the occurrence of multiple spontaneous arteriovenous fistulas with peripheral artery disease is rare. Herein we describe a rare case of critical limb ischemia, generally caused by arteriosclerosis, with multiple spontaneous arteriovenous fistulas and peripheral artery disease.
An 83-year-old woman with a history of diabetes mellitus, hypertension, and diabetic nephropathy visited our hospital. An ulcer haddeveloped on her left first toe after surgery of an ingrown nail. She was diagnosed with critical limb ischemia due to decreased skin perfusion pressure in her lower leg. Angiography revealed multiple arteriovenous fistulas and severe peripheral artery disease. Below-knee amputation was initially ruled out because of lower leg ischemia. Thus, we first attempted partial ligation of the arteriovenous fistulas of the popliteal region to improve blood flow in the lower leg. Subsequently, we performed below-knee amputation without any complications. In conclusion, we were able to improve blood flow in the lower leg with partial arteriovenous fistula ligation surgery and preserved the knee joint.