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

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.

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

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.)

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

Carotid-jugular fistula is a rare presentation of arteriovenous fistula. A case of a 60-year-old Chinese man who presented with iatrogenic carotid-jugular fistula with multiple fistulous points was reported. His presenting complaint was a gradually enlarging right pulsatile neck mass complicated by worsening symptoms of congestive cardiac failure. He had recent mitral valve annuloplasty, and a right internal jugular central venous pressure monitor insertion was performed then. Angiography revealed right carotid-jugular fistula with feeders from the external carotid, internal carotid and right vertebral arteries, all draining into the right internal jugular vein. He underwent embolisation twice resulting in transient improvement in clinical symptoms, and surgical resection was later performed in view of residual arteriovenous shunting and gradual clinical deterioration. Following surgery, he was discharged and resumed work as a janitor with no recurrent symptoms for 3 years now. In this report to be added into the literature, we discuss a rare case of iatrogenic carotid-jugular fistula with multiple fistulous points which required embolisation and subsequently surgical resection.

Rare cause of a neck mass: successful balloon embolisation of a congenital external carotid artery-internal jugular vein fistula

Congenital arteriovenous fistulas are a rare cause of neck mass in children, but should be considered in the differential diagnosis of paediatric patients presenting with pulsatile neck masses even when there is no history of trauma. Balloon embolisation is the treatment of choice because of the high risk of surgical complications in this region.