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Table of Contents
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Year : 2013  |  Volume : 16  |  Issue : 4  |  Page : 281-282
A dangerous communication


1 Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768228, Republic of Singapore
2 Department of Diagnostic Radiology, School of Medical Sciences, International Medical University, Kuala Lumpur 57000, Malaysia

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Date of Web Publication1-Oct-2013
 

How to cite this article:
Srinivasan S, Teh HS, Wei DE. A dangerous communication. Ann Card Anaesth 2013;16:281-2

How to cite this URL:
Srinivasan S, Teh HS, Wei DE. A dangerous communication. Ann Card Anaesth [serial online] 2013 [cited 2019 Jul 22];16:281-2. Available from: http://www.annals.in/text.asp?2013/16/4/281/119179


A 73-year-old woman with a history of end-stage renal failure on long-term hemodialysis presented with blocked right-sided radiocephalic arteriovenous fistula. Insertion of a temporary central venous hemodialysis catheter was planned. After the insertion of central venous catheter in the right internal jugular vein (IJV), there was a suspicion of inadvertent arterial cannulation; therefore, the cannula was immediately pulled out. However, patient developed increasing swelling at the site of puncture. Computed tomography (CT) of the neck revealed a fistulous communication [Figure 1]a and b between the right common carotid artery (CCA) and right IJV at the level of C7/T1 vertebral bodies associated with a right carotid sheath hematoma. The volume-rendered automated dual-energy based bone subtraction 3D CT image clearly showed the shape and orientation of the fistulous tract [Figure 2]. Patient underwent successful deployment of a balloon expandable 10 mm × 59 mm covered stent (Atrium Medical Inc., USA) in the right CCA to exclude the abnormal communication.
Figure 1: Iatrogenic carotid-jugular fistula, (a) axial post-contrast computed tomography (CT) (thin maximum intensity projection) section and (b) oblique sagittal post-contrast CT section showing the fistulous tract

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Figure 2: Volume rendered image (oblique view) showing the tortuous fistulous tract (arrow head) between the right common carotid artery (long arrow) and internal jugular vein (small arrow)

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Reports of iatrogenic carotid-jugular fistula following insertion of central venous catheters have been described. [1],[2] The IJV cannulation under ultrasonography guidance is expected to prevent such complications. Immediate recognition and management are vital to prevent potential complications such as high-output cardiac failure or stroke. [3],[4] Although, traditionally such cases are treated by surgery, endovascular management is an alternative safe option.

 
   References Top

1.Droll KP, Lossing AG. Carotid-jugular arteriovenous fistula: Case report of an iatrogenic complication following internal jugular vein catheterization. J Clin Anesth 2004;16:127-9.  Back to cited text no. 1
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2.Patel HV, Sainaresh VV, Jain SH, Kute VB, Godara S, Gumber MR, et al. Carotid-jugular arteriovenous fistula: A case report of an iatrogenic complication following internal jugular vein catheterization for hemodialysis access. Hemodial Int 2011;15:404-6.  Back to cited text no. 2
[PUBMED]    
3.Bahcebasi S, Kocyigit I, Akyol L, Unal A, Sipahioðlu MH, Oymak O, et al . Carotid-jugular arteriovenous fistula and cerebrovascular infarct: A case report of an iatrogenic complication following internal jugular vein catheterization. Hemodial Int 2011;15:284-7.  Back to cited text no. 3
    
4.Ezemba N, Ekpe EE, Ezike HA, Anyanwu CH. Traumatic common carotid-jugular fistula: Report of 2 cases. Tex Heart Inst J 2006;33:81-3.  Back to cited text no. 4
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Correspondence Address:
Sivasubramanian Srinivasan
Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828
Republic of Singapore
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.119179

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