Acquired Carotid-Jugular Fistula: Its Changing History and Management

Abstract

Purpose. To highlight the changes that have come about in recent years in the etiology, diagnosis, and treatment of acquired carotid-jugular fistulas.Methods. We present a review of the literature on acquired carotid-jugular fistulas (CJFs), which includes studies from World Wars I and II up to today and a retrospective analysis of the lesion reports published in the period 2000–2012, with an update of Talwar's table. The case study of one patient suffering from an untreated, long-standing CJF recently treated by us is also presented and included in the updated table.Results. Thanks to early treatment of acute lesions by reconstructive and endovascular surgery, incidence of posttraumatic carotid-jugular fistulas is decreasing, while the number of iatrogenic ones due to medical advances is concomitantly increasing, specifically because of the ever more widespread use of central venous catheters for venous pressure monitoring, parenteral nutrition, and hemodialysis.Conclusion. Although such lesions seem destined to diminish in the future thanks to the above-mentioned diagnostic and therapeutic advances, the increasing number of internal jugular vein catheterizations performed worldwide implies that physicians will still be dealing with carotid-jugular fistulas for many years to come.

Surgical resection of carotid-jugular arteriovenous fistula after multiple failed embolisation

“…Acquired CJFs are rare entities that can only be encountered as case reports in the medical literature 1 2 6 7. It was interesting to note that prior to 2000, as denoted by Talwar et al ’s2 review, majority of the acquired CJFs were due to gunshot or stab injuries, as compared with after 2000.…”

“…It can either be congenital or acquired. Congenital causes are much less common, usually associated with collagen vascular disease, while acquired fistulas are frequently the result of penetrating trauma including iatrogenic causes, for example, internal jugular vein (IJV) catheterisation for central venous pressure (CVP) monitoring 1…”

“…Endovascular treatment by stent grafts and coils is gaining favour today. There are no case series or long-term follow-up study conducted to compare the treatment options, although lower mortality rate associated with endovascular repair versus open surgery has been reported 1. Early diagnosis and treatment of CJFs is important to avoid complications, including congestive cardiac failure and systemic embolisation 1…”

“…The recent management of a case of CJF gave us the starting point to review the literature on this lesion. The most recent review on acquired CJFs has come from Caldarelli et al ,1 who in 2013 described a fistula between the right common carotid artery (CCA) and right IJV treated by surgical ligation of the fistulous tracts. His work was built on a review done by Talwar et al 2 in 2000.…”

“…Talwar et al ’s2 review included 30 CJFs of which only 9 were acquired. Caldarelli et al ’s1 review added on another 24 cases of acquired CJFs. We have reviewed the literature and now add four more cases to the collection of cases of CJFs,3–5 including ours.…”