Correction of carotid-jugular traumatic fistula using a bovine pericardial patch

Abstract

Carotid-jugular fistulae are rare, but habitually cause morbidity and mortality. They are often linked with penetrating trauma, primarily caused by gunshots. This report describes the case of a patient who was the victim of a gunshot wound to the left cervical area, provoking a carotid-jugular arteriovenous fistula and occlusion of the common carotid artery. The fistula was corrected by ligature of the internal jugular vein and arteriorrhaphy of the left common carotid artery with a bovine pericardium patch.

Caso clínico: Fístula carótido-yugular: complicación inusual de cateterismo venoso central

“…9,13 La reparación quirúrgica por vía convencional incluye: identificación del trayecto fistuloso y su reparación, que varía desde: sutura lateral, anastomosis terminoterminal, interposición de implante venoso y reparación usando parches o ligadura. 14 Esta modalidad es preferible en pacientes con lesiones de la pared del vaso asociadas, tales como pseudoaneurismas y lesiones traumáticas extensas. Los riesgos son variables en ambos procederes, mayores en la cirugía abierta, pueden presentarse desde sangrados masivos, lesiones de estructuras nerviosas, dolor postoperatorio, mayor estancia hospitalaria, cicatriz hipertrófica con repercusiones estéticas, e incluso el síndrome de hipoperfusión cerebral, dado por revascularización cerebral o tromboembolismo.…”

Correção cirúrgica de fístula carotídeo-jugular traumática

“…[16][17][18] Immediate surgical intervention is indicated in cases with evident vascular injury and hemodynamic instability. 8 Elective treatments should be preceded by careful therapeutic planning, including anatomic assessment of the structures involved. 4,12 AngioCT, magnetic resonance imaging (MRI), and Doppler ultrasonography are often employed and, in some cases, angiography can play an important role in planning, whether for conventional, endovascular, or hybrid surgery.…”

“…2,3 The great saphenous vein can be used, with low rates of thrombosis and infection, but this requires an additional incision in the lower limb, with consequent increase in the duration of surgery. 2,8 Considering the benefits of an autologous graft, and since the external jugular vein was already dilated, with thickening of the wall (because of pressurization by the AVF), the surgical team decided to use it, avoiding the need for additional incisions and reducing the duration of the operation.…”