Iatrogenic cervical arterio-venous fistula

Area of Science:

• Vascular Surgery
• Nephrology
• Interventional Radiology

Background:

• Arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis.
• High rates of central venous catheter (CVC) placement persist for patients initiating hemodialysis or with fistula dysfunction.
• CVC insertion carries risks including infection, thrombosis, and arterial injuries.

Observation:

• A 53-year-old female patient developed an iatrogenic arteriovenous fistula.
• The fistula was between the right subclavian artery and the right internal jugular vein.
• This complication resulted from a malpositioned internal jugular central venous catheter.

Findings:

• Surgical intervention was performed via median sternotomy and supraclavicular approach.
• The iatrogenic AVF was successfully excluded.
• Direct suture repair of the subclavian artery and internal jugular vein was achieved.

Implications:

• This case demonstrates a rare but serious complication of central venous catheterization.
• Successful surgical management of iatrogenic AVFs is feasible.
• Highlights the importance of careful catheter placement and awareness of potential vascular injuries.