Do Arteriovenous Fistula Of The Superficial Temporal Artery Repair On Their Own

Introduction

Arteriovenous fistulae is direct advice between feeding high catamenia arterial segment and the low menses venous drainage organization without intervening capillaries, resulting in a pulsatile, tortuous dilated vein. Patient may present with various clinical manifestations, such as bruits, tinnitus, local pain, hemorrhage, and disfiguring lesion.^i–iii

Traumatic arteriovenous fistula is arteriovenous shunting secondary to blunt, penetrating and iatrogenic trauma of artery and vein running in parallel, but rarely occur in the superficial temporal avenue.

Arteriovenous fistula of the superficial temporal vessel is a rare condition with incidence of 0.5% to ii.0%; 75% of superficial temporal arteriovenous fistula is caused by blunt, penetrating or iatrogenic trauma.^3,four

In 90% of the patients with scalp arteriovenous fistula, superficial temporal vessel was involved. Several methods, such as open surgical removal, ligation of the feeding trans-vascular embolization, and intra-lesion injection of sclerosant, have been used to treat these cases.ⁱ

As to the knowledge of authors, there were no eports of superficial temporal vessel fistula in Africa. Throughout the world, superficial temporal vessel caused by penetrating injury is extremely rare and at that place is no report of thorn injury causing this fistula. The objective of this instance written report is to describe a case of extremely rare traumatic arteriovenous fistula of the temporal superficial vessel caused by thorn injury (penetrating) treated surgically in Ethiopia. Therefore, this case study tells us thorn injury tin can crusade arteriovenous fistula.

Case Report

A 35-twelvemonth-one-time female patient from rural area of Ethiopia presented with left lateral and scalp swelling of 15 years duration later she initially sustained thorn injury over the left preauricular area. At that time she had history of mild bleeding and she improved. Just later, after 2 months of trauma, a pocket-sized swelling started at the site of thorn injury and then gradually and progressively involved the left upper lateral face up and scalp area. In addition to swelling she had bruit, headache and tinnitus in left ear. Otherwise, she had no history of other trauma, smoking, chronic medical illness or alcohol utilize. For the higher up complaint, the patient went to nearby health middle from where she was referred to Madda walabu University Goba Referral Hospital, Southeast Ethiopia.

Upon physical test she was conscious and healthy looking, with the following vital signs: blood pressure 120/70 mm Hg, pulse charge per unit of 90 beats per infinitesimal, temperature of 36.iv °C and respiratory rate of 20 breaths per minute. She had pink conjunctiva, non-icteric sclera and moisture tongue. There was significant dilated, tortuous, visible pulsatile vessel over the left preauricular and scalp area. Skin overlying dilated vessel was normal and upon palpation in that location was significant pulsation and bruit sound heard upon auscultation over pulsatile mass.

With the impression of traumatic superficial temporal vessel arteriovenous fistula, the patient was investigated with hemoglobin of 13.6gm/dl, white blood cell of 12,300/Fifty platelet was 160,000/microliter. Doppler ultrasound confirmed arteriovenous fistula of superficial temporal vessel. But CT angiography was not washed due to absence of such a service in the area.

With same diagnosis, patient was operated and intra-operative finding was pulsatile dilated superficial vessel. Feeding superficial temporal vessel was ligated at level of left ear. The patient was followed for 2 months and swelling was resolved and there was no recurrence (Figure 1).

Effigy i Picture showing pulsatile tortuous mass over left lateral face up and scalp region in a 35-yr-sometime female person patient.

Discussion

The superficial temporal avenue is vulnerable to trauma because of its superficial path over the temporal bone and proximity to cranial sutures and because the superficial temporal artery and superficial temporal vein run in parallel with each other over the temporal os. In addition to trauma, it tin can occur spontaneously or exist caused by surgical procedures. Traumatic superficial temporal vessel fistulae develop over the course of months or years after the trauma. Spontaneous superficial temporal vessel fistulae may be nowadays congenitally, fifty-fifty though the majority of cases remain asymptomatic until puberty.³

In general, the virtually mutual symptoms of arteriovenous fistula of the scalp are localized headache, a pulsatile subcutaneous mass and pulsatile tinnitus. Physical test findings are: dilated and tortuous vessel, bruit on auscultation of the mass, pulsatile vibration on palpation, and Terrier's sign.⁵ One should consider superficial temporal arteriovenous fistula for possible cause of unilateral headache if patient felt bruit in ipsilateral ear.

Diagnosis of a traumatic fistula of the superficial temporal vessel is based on a history of trauma and a detailed physical examination. But angiography remains the gold standard investigation.

In that location are two possible mechanisms explaining pathophysiology of traumatic arteriovenous fistulae formation in the scalp. The kickoff 1 is simultaneous laceration of the side by side artery and vein. The second ane, starts with the rupture of vasa vasorum in the artery wall, which stimulates endothelial proliferation from damaged vasa vasorum and so forms numerous small vessels, leading to vascular connection between the ii vessels. In our case, since thorn injury is a penetrating injury, it results in vascular fistula highly probable caused past the first machinery.

Surgical excision, ligature of the feeding vessels, embolization and injection of sclerosing agents into the lesion are common handling options, but surgical removal of the pulsating mass and ligature of the feeding vessel remains standard handling.

The master advantage of embolization of this arteriovenous fistula is to reduce claret loss, but gamble of recurrence is high, especially for complex fistula if done alone.^ane,3,vi

Consent

Written consent was taken from our patient and recorded on patient consent class and also the patient provided written consent for the publication of her case, including images of her case, and hence we can provide if requested. However, institutional approval is not required to publish the case because nosotros did not take whatsoever sample or exercise whatever procedure on the patient for research purposes. We only treated the patient and reported her case and the patient provided written consent for the publication of her instance. Institutional approval is needed when samples are taken or procedures are washed for research purposes.

Disclosure

The authors declare that in that location is no conflict of involvement in this work.

References

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