Iatrogenic central arterio-venous fistula-case report

Area of Science:

• Vascular Surgery
• Nephrology
• Interventional Radiology

Background:

• Permanent dialysis catheters, while essential for hemodialysis, carry inherent risks.
• Central arterio-venous fistulas (cAVFs) are an uncommon but serious complication associated with central venous catheter insertion.

Observation:

• A 43-year-old female developed a cAVF between the innominate vessels following insertion of a tunneled hemodialysis central venous catheter (HD-CVC) via the left internal jugular vein (IJV).
• Clinical presentation included progressive left neck swelling, supra-clavicular fullness, dyspnea, and high-output cardiac failure.
• Impending rupture at the catheter insertion site necessitated urgent surgical intervention.

Findings:

• This case represents the first reported instance of an innominate arterio-venous fistula (AVF) occurring post-HD-CVC placement.
• Surgical management involved sternotomy and successful ligation of the arterio-venous communication.

Implications:

• This report underscores the importance of recognizing rare vascular complications associated with central venous catheterization.
• Prompt diagnosis and surgical intervention are crucial for managing life-threatening complications like cAVF.
• Highlights the need for vigilance in monitoring patients with HD-CVCs for potential vascular abnormalities.