[A case of A-V fistula with severe hemolysis following internal jugular venipuncture]

Severe hemoglobinuria was observed in a case with abdominal aortic aneurysm on the 23rd postoperative day. The typical continuous murmur was heard on the right upper chest, and IADSA revealed an A-V fistula connecting between the right subclavian artery and the internal jugular vein. This A-V fistula was thought to have been caused by an inadvertent arteriopuncture during the central venous cannulation at the time of the operation. Poloxamer 188 (a non-ionic surfactant) and haptoglobin were given intravenously, and they proved to be quite effective in improving intravascular mechanical hemolysis and hemoglobinuria. A division of the A-V fistula was done successfully, which was facilitated by the median sternotomy combined with the extension of the skin incision to the neck. It cannot be overemphasized that utmost care should be taken to prevent any complication at the time of the central venous cannulation.