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.
Embolization of a bullet or shrapnel from the heart (left ventricle) to the peripheral arterial circulation is practically unknown. We present a 38-year-old man with no comorbidities who was referred to our centre with a bullet injury to the left side of his chest. The patient complained of mild pain and numbness in his right lower limb. A trauma series was advised. A contrast angiogram of the peripheral lower limbs showed a bullet in the right popliteal artery with no flow in the tibial arteries. A bullet was removed from the distal popliteal artery at its bifurcation with a long thrombus proximal to it. Removal of the foreign body is the widely accepted management, especially when it leads to symptoms like ischaemia or signs of infection, as was the situation in our case.
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