External Carotid Artery-Jugular Vein Fistula Caused by Blunt Trauma: A Case Report & Literature Review

Abstract

Acquired carotid-jugular fistula usually occurs due to neck stab wounds, gunshots, or central vein catheterization. Blunt trauma is a rare cause. These cases usually present with pulsatile swelling, tinnitus, and continued thrills in the neck. Both surgical and endovascular options have been used to manage these fistulas. Coil embolization is also applied in high-flow fistulas. We present a case of a 38-year-old woman free of any pre-existing medical conditions, presenting with a fistula between the external carotid artery and external jugular vein distally and with a high flow. She was treated with fistula embolization using coils while limiting the high flow via a balloon in the jugular vein. Our case highlights the possibility of using coils in high-flow fistulas in anatomically challenging fistulas. Furthermore, relevant literature review is presented to recapitulate unique features and effective management of carotid-jugular fistulas.

Successful Endovascular Treatment of a Traumatic Cervical Arteriovenous Fistula After a Carotid Paraganglioma Resection: A Case Report

“…CAVFs are rare entities; they account for only 4% of all AVFs, and so far, all the information on its epidemiology is comprised of case reports [ 1 ]. Although CAVFs are associated with different types of traumas like central line insertions, gunshot wounds, and neck surgical procedures, the vascular injury seems to be the only constant in all acquired cases, independent of the trauma mechanism, even if it is blunt trauma [ 1 , 2 ]. The symptoms caused by AVFs are mainly from retrograde venous congestion (headache, swelling, pulsatile mass, or even glaucoma) or from decreased distal arterial supply (syncope) [ 5 , 6 ].…”

“…An arteriovenous fistula (AVF) is an anomalous connection between the arterial and venous systems without an intervening capillary network. AVFs can be caused by iatrogeny, penetrating trauma, or, rarely, blunt trauma, resulting in high-pressure arterial blood draining directly into a vein, decreasing distal perfusion [1][2][3].…”

Manejo endovascular de una fístula carótido-yugular postraumática

“…La confirmación diagnóstica se puede A B realizar con ecografía Doppler cervical, la cual es no invasiva y accesible 2,7 , sin embargo los estudios de elección son la angiografía por resonancia magnética o por tomografía computarizada, que permiten conocer la ubicación precisa y el tamaño de la fístula antes de la intervención quirúrgica 2,6 . El manejo de las FAV cervicales no se debe retrasar debido al desarrollo de fibrosis y de circulación colateral que aumenta el riesgo de sangrado operatorio 5 . Además, estas deben ser tratadas para evitar complicaciones tardías como insuficiencia cardiaca de alto gasto, fibrilación auricular o embolización 2,7 .…”

“…La primera descripción de esta entidad la realizó Warrant en 1951 4 . Las fístulas carótido-yugulares representan el 4% de las FAV traumáticas 5 . Su principal causa son los traumas cortopunzantes seguidos de las lesiones por arma de fuego 6 ; en los últimos años, las lesiones iatrogénicas han tomado un papel importante en esta patología.…”