Acquired arteriovenous fistula is an unusual complication of lumbar disc surgery. Diagnosis is often late because of the lack of awareness of this complication and also because it may simulate other vascular diseases. A case diagnosed initially as deep vein thrombosis of the leg is described.
A case of A. V. fistula of the superior thyroid vessels following thyroidectomy is reported. Though the standard treatment of such a fistula is ligation and excision, a more simple Iigation and division of the superior thyroid artery is adequate for reasons mention. The demonstration of the feeding vessel by angiogram has to be accurate.
Incidence of inadvertent arterial puncture secondary to central venous catheter insertion is not common with an arterial puncture rate of <1%. This is due to the advancements and wide availability of ultrasound to guide its insertion. Formation of arteriovenous fistula after arterial puncture is an unexpected complication. Till date, only five cases (including this case) of acquired arteriovenous fistula formation has been described due to inadvertent common carotid puncture. The present case is a 26-year-old man sustained traumatic brain injuries, chest injuries and multiple bony fractures. During resuscitative phase, attempts at left central venous catheter via left internal jugular vein under ultrasound guidance resulted in inadvertent puncture into the left common carotid artery. Surgical neck exploration revealed that the catheter had punctured through the left internal jugular vein into the common carotid artery with formation of arteriovenous fistula. The catheter was removed successfully and common carotid artery was repaired. Postoperatively, the patient recovered and clinic visits revealed no neurological deficits. From our literature review, the safest method for removal is via endovascular and open surgical removal. The pull/push technique (direct removal with compression) is not recommended due to the high risk for stroke, bleeding and hematoma formation.