Arteriovenous fistula complicating directional atherectomy of the popliteal artery

We describe a case of a 70-year-old man with a critical popliteal artery stenosis treated by directional atherectomy and complicated by a huge arteriovenous fistula. A 70-year-old man, previously treated by bilateral femoropopliteal bypass, was admitted to our hospital because of right leg intermittens claudication. A critical infrapopliteal stenosis was documented; this lesion was treated by directional atherectomy, which was complicated by a huge arteriovenous fistula. Due to the failure of any conservative approach, surgical repair was necessary. Following surgery, the patient was discharged without any deficit. Although rare, huge arteriovenous fistula may be a serious complication of peripheral directional atherectomy.