Congenital Arteriovenous Fistula in a Nine-Year-Old Child: A Case Report

Congenital external carotid-jugular fistula is a rare condition caused by altered embryologic development of the vasculature. It is usually treated with surgery or endovascular embolization; controversy exists on the best therapeutic approach and the specific endovascular technique. We report a case of a complex congenital fistula between the external carotid and jugular veins treated with a combined trans-arterial dual microcatheter coiling technique followed by n-BCA (n-butyl cyanoacrylate) glue embolization. After performing a balloon occlusion test to localize the exact fistulous point, dual microcatheter coiling allowed flow reduction and proper packing without balloon assistance. Due to the superficial location of the fistula, the use of n-BCA glue embolization glue guaranteed complete occlusion, avoiding the skin discoloration that Onyx, the standard embolic agent used in fistulas, might cause. This combined endovascular technique provides a safe and simple strategy to optimize efficacy and aesthetic outcomes in a young child with a congenital carotid-jugular fistula.