Congenital Carotid–Jugular Fistula in a Child

Abstract

Congenital carotid-jugular (CJ) fistula of the neck is a very rare clinical entity that has various causes. The CJ fistulas are particularly prone to complications unlike other peripheral arteriovenous fistulas. The aim of this report is to present a case of a CJ fistula between the external carotid and the external jugular vein, which was successfully closed with detachable balloon by an endovascular approach. A 14-year-old child was admitted to our clinic with a pulsatile neck swelling. There was no previous history of trauma. A high-flow fistula between the external carotid and the external jugular vein was determined. The fistula was closed with detachable balloon by an endovascular approach. The postoperative angiogram demonstrated complete resolution of the fistula. Endovascular treatment of CJ fistulas with detachable balloons is a safe and less traumatic technique and may be an effective alternative to the open surgery in selected patients.

Endovascular Treatment of Congenital Internal Carotid-Jugular Fistula

“…Congenital carotid-jugular fistulas were usually reported in children (1, 2), but the patient in this case had the first symptom at the age of 64. Pulsatile mass swelling is the main clinical manifestation.…”

“…A carotid-jugular fistula is a direct communication between the carotid artery and the jugular vein, and usually reported in children (1, 2). Congenital and spontaneous internal carotid-jugular fistulas are extremely rare (3, 4).…”

Embolization of a congenital arteriovenous fistula of the internal maxillary artery: A case report and review of the literature

“…8 The majority of arteriovenous fistulas in the neck are usually associated with trauma, surgery, or extensive infection of the neck. Kim et al 1 states that the natural history of congenital arteriovenous fistula of the IMA is usually benign so treatment can be delayed if the fistula is well tolerated.…”

Endovascular Management of an Acquired Carotid-Jugular Fistula in a Child

“…Carotid jugular fistulas (CJF) are an uncommon clinical entity [ 2 – 4 ]. Although rare, they can be congenital, however, the majority of pediatric cases are due to neck trauma, with penetrating injuries the most common of these [ 3 , 5 ]. Their presentation, which depends on the hemodynamic effects and degree of arterial to venous shunting, can be subtle and this often leads to delays in diagnosis of weeks or even months following the initial injury [ 2 , 4 , 6 ].…”

“…DUS is usually the initial diagnostic modality; however, it is operator dependent and cannot completely exclude CJF [ 3 ]. CTA or magnetic resonance angiography (MRA) is therefore usually performed to provide the necessary imaging required to plan treatment which aims to seal the fistula and maintain forward antegrade flow to the brain [ 5 , 7 , 8 ]. Conventional surgical ligation, division of the fistula, and vascular reconstruction was traditionally the treatment of choice, but this carries a significant morbidity and requires technical expertise owing to the small vessel diameter, relative surgical inaccessibility, and potentially scarring in the not infrequent case of delayed diagnosis [ 8 ].…”