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Surgical resection of carotid-jugular arteriovenous fistula after multiple failed embolisation
  1. Luen Shaun Chew,
  2. Julian Xinguang Han,
  3. Yew Poh Ng and
  4. Hua Bak Ng
  1. Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
  1. Correspondence to Dr Luen Shaun Chew, shaunchew{at}


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.

  • neurosurgery
  • vascular surgery
  • head and neck surgery

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  • LSC and JXH contributed equally.

  • Contributors LSC and JXH have contributed equally to the work. LSC: planning, conduct, reporting, design, acquisition of case details. JXH: planning, reporting, acquisition of case details. VYPN: conduct, interpretation of case information, operative surgeon. IHBN: conduct, operative surgeon.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.