False aneurysm and arteriovenous fistula between the popliteal artery and popliteal vein one year after a shrapnel wound: surgical reconstruction in a military field hospital in a special military operation zone

A 41-year-old serviceman. A year ago, while performing a combat mission in the Special Military Operations (SMO) zone, he sustained a blind shrapnel wound to his right lower extremity as a result of a shell explosion. The metal fragment was not removed due to its deep location in the tissue of the lower leg. The wound healed by primary intention, and he returned to military service 10 days after seeking medical attention. Six months later, he felt the development of a tumor-like rounded mass in his right popliteal region, which continued to grow. A year after the injury, he developed numbness in his foot and decreased sensation in his fingers. An ultrasound examination revealed a false aneurysm of the popliteal artery (PA) and an arteriovenous fistula (AVF) between the PA and popliteal vein (PV). Due to the risks of transporting the patient to a specialized hospital during active combat operations and the progression of tibial nerve neuropathy symptoms, a decision was made to perform reconstructive surgery at a military field hospital in the SMO zone. The following surgery was performed: removal of the PA false aneurysm, removal of the AVF between the PA and PV, and autologous vein grafting of the PA with a reversed great saphenous vein. The postoperative period was uneventful. Symptoms of tibial nerve neuropathy regressed 14 days after surgery. The patient was discharged and returned to military service 30 days after surgery.

1. Esipov A.V., Alekhnovich A.V., Frolkin M.N. Experience in treating combat trauma and surgical infection. Military Medical Journal. 2024;345(10):91–94. (In Russ.). https://doi.org/10.52424/00269050_2024_345_10_91

2. Sudakov D.V., Sudakov O.V., Sych G.V., Gordeeva O.I. Comparative analysis of the effectiveness of instrumental diagnostic methods in patients with complex shrapnel wounds of the upper extremities. Systems analysis and control in biomedical systems. 2024; 23(4):33–43. (In Russ.) https://doi.org/10.36622/1682-6523.2024.23.4.005

3. Kharchenko O.Yu., Kazantsev A.N., Alekseev O.V., Makhmudov R.M., Kholmatov V.N., Tenishev R.R. Resection of false posttraumatic aneurysm of the axillary artery within a separate medical airmobile detachment in special military operation zone. Pirogov Russian Journal of Surgery. 2025;(6):122 127. (In Russ.). https://doi.org/10.17116/hirurgia2025061122

4. Gavrilov E.K., Zokhrabov F.I., Zangiev E.A., Khubulava G.G. Surgical treatment of gunshot damage to deep veins in modern armed conflict. Journal of Venous Disorders. 2024;18(4):283 292. (In Russ.). https://doi.org/10.17116/flebo202418041283

5. Gavrilov E.K., Zokhrabov F.I., Zamsky K.S., Khubulava G.G. Clinical and instrumental features of traumatic arteriovenous fistulas after gunshot wounds of the lower extremities. Journal of Venous Disorders. 2025;19(2):95 104. (In Russ.). https://doi.org/10.17116/flebo20251902195

6. Belik B.M., Dadayan A.R., Tenchurin R.Sh. Efficiency of intraoperative ultrasound guidance in removing soft tissue foreign bodies located in areas with complex surgical anatomy after gunshot shrapnel wounds. Emergency Medical Care. N.V. Sklifosovsky Journal. 2025;14(2):328–337. (In Russ.). https://doi.org/10.23934/2223-9022-2025-14-2-328-337

7. Kholmatov V.N., Kazantsev A.N., Bolibok N.V., Belyai Zh.M., Tenishev R.R., Gaptrakipov I.Kh. Surgical treatment of mine-blast wound with the formation of a false aneurysm of the popliteal artery in a military field hospital of a special military operation zone. Politravma. 2025;3:44–50. (In Russ.). https://doi.org/10.24412/1819-1495-2025-3-44-50

8. Kyshtymov S.A., Belov A.K., Simashko A.A., Grigoriev E.G. Mine-blast injury of the knee joint with damage to the popliteal artery. Polytrauma. 2025;1:41–45. (In Russ.). https://doi.org/10.24412/1819-1495-2025-1-41-45

9. Kabirov A.V., Vasin A.S., Grachev A.M., Panfilov S.D. Thromboembolism of the palmar arches, digital arteries against the background of posttraumatic aneurysm of the left brachial artery. Angiology and vascular surgery. Journal named after academician A.V. Pokrovsky. 2013; 19(2):147–151. (In Russ.). EDN: OKQUKS

10. Leshchinskaya O.V., Kudryashova N.Y., Mikhaylov I.P., Chernysheva O.A., Migunova E.V., Lbova O.A. Post-Traumatic pseudoaneurysm of femoral artery associated with arteriovenous fistula in a 32-year-old male patient (clinical observation). Russian Sklifosovsky Journal. Emergency Medical Care. 2019;8(4):458–462. (In Russ.). https://doi.org/10.23934/22239022-2019-8-4-458-462

11. Steklov V.I., Krasnikov M.P., Gorin D.Yu., Morozova N.V. Dissociation of posttraumatic arteriovenous fistula on the leg. Pirogov Russian Journal of Surgery. 2025;(9):128 133. (In Russ.). https://doi.org/10.17116/hirurgia2025091128

12. Petrov K.Yu., Zamsky K.S., Gaidukov A.V., Pecherskaya M.S., Kranin D.L., Zaslavskaya M.A., Golovushkina G.V. Application of endovascular and hybrid techniques for surgical treatment of traumatic gunshot arteriovenous fistulas of the extremities. Bulletin of the Pirogov National Medical and Surgical Center. 2024;19(2):148–153. (In Russ.). https://doi.org/10.25881/20728255_2024_19_2_148

13. Kozlov B.N., Kuznetsov M.S., Panfilov D.S., Nasrashvili G.G., Bogdanov Yu.I., Katkov V.A., et al. Clinical case of arteriovenous fistula separation in patient with post-traumatic arteriovenous false aneurysm. Russian Journal of Cardiology and Cardiovascular Surgery. 2015;8(5):6468. (In Russ.). https://doi.org/10.17116/kardio20158564-68