Traumatic Common Carotid–Internal Jugular Arteriovenous Fistula Manifesting as Life-Threatening Epistaxis

Abstract

Post-traumatic common carotid artery–internal jugular vein fistula is extremely rare (4% to 7% of all traumatic arteriovenous fistulas). Clinical manifestations depend on the size, duration, and proximity to the heart. This report describes a case where the condition remained undiagnosed for years, and the patient was recently treated with transsternal ligation of the left common carotid artery. ( Level of Difficulty: Advanced. )

A Central Venous Catheter Line Misadventure

“…11 Another rare complication of IJV catheterisation is traumatic CCA-IJV fistula (CJF). 2 Traumatic CJF has an incidence of 4–7% of all traumatic AVFs and it can be iatrogenic or due to penetrating injuries such as gunshots or stab injuries. 2 Although it is considered a rare entity, there are several cases reported and published where an iatrogenic AVF was created by central venous catheterisation of the IJV.…”

“… 2 Traumatic CJF has an incidence of 4–7% of all traumatic AVFs and it can be iatrogenic or due to penetrating injuries such as gunshots or stab injuries. 2 Although it is considered a rare entity, there are several cases reported and published where an iatrogenic AVF was created by central venous catheterisation of the IJV. 2 , 6 , 12 , 13 If left untreated, it can lead to further serious life-threatening complications such as embolisation, infection and at later stages high-output cardiac failure.…”

“… 2 Although it is considered a rare entity, there are several cases reported and published where an iatrogenic AVF was created by central venous catheterisation of the IJV. 2 , 6 , 12 , 13 If left untreated, it can lead to further serious life-threatening complications such as embolisation, infection and at later stages high-output cardiac failure. 2 Therefore, early detection and intervention is crucial to prevent such consequences.…”

“…An arteriovenous fistula (AVF) is an abnormal communication between an artery and vein. It can occur as a congenital anomaly 1 or iatrogenic during any arterial or venous instrumentation, trauma, or endovenous thermal ablation 2 . One of the earliest cases of iatrogenic AVF was published by James and Myers in 1973.…”

“…It can occur as a congenital anomaly or iatrogenic during any arterial or venous instrumentation, trauma or endovenous thermal ablation. 1 , 2 One of the earliest cases of iatrogenic AVF was published by James and Myers in 1972. 3 The incidence of iatrogenic AVFs has previously been described to be less than 0.6% of central line insertions.…”