The difficulties in detecting vascular injuries associated with penetrating limb trauma are greater than generally appreciated. Any delay in diagnosis will compromise management and potentially may lead amputation. Traumatic arteriovenous fistulas (AV fistula) produce several profound pathophysiological and structural changes in the circulatory dynamic of the vessel associated with fistula. Most of the changes are reversible after surgery. However, in longstanding AV fistulas, irreversible degenerative changes occur in the arterial wall and result in dilation and thrombosis. This can make late closure technically difficult. This report presents a case of a femoral AV fistula persisting for three years durations.