The most common cause of acquired femoral artery venous (AV) fistula is penetrating trauma sustained during diagnostic or interventional cardiovascular procedures involving femoral artery or vein access. The diagnosis is usually made by duplex imaging and confirmed by computed tomography angiography (CTA) and catheter-based digital subtraction angiography (DSA). Most femoral AV fistulas need surgical repair using a groin incision, thereby obtaining proximal distal control of the fistula. Proximal and distal control of the vein is usually not necessary.