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.