A 74-year-old New Zealander who still hiked, cycled and ran was referred to a cardiology clinic with newly diagnosed atrial fibrillation, breathlessness, fatigue and a left leg that had been swelling for two years. His family doctor tried a diuretic, and it barely helped. His heart chambers were enlarged but pumping normally, and there were no signs of fluid in his lungs. What eventually unraveled it was a single question asked during an ultrasound scan.
He had been struck by an ice axe on Aoraki Mount Cook in 1997, with punctures to his face and left thigh. Twenty-seven years later, the wound was still open on the inside. His doctors found an arteriovenous fistula, an abnormal channel letting blood dump straight from his superficial femoral artery into the neighboring femoral vein. The case report in Experimental Physiology, from a team at the University of Otago and Dunedin Hospital, appears to be the first documented instance of one caused by an ice axe.
