Iatrogenic central arterio-venous fistula-case report

Iatrogenic complications provide insight into the limitations of procedures. Complications associated with insertion of permanent dialysis catheter are numerous but central arterio-venous fistulas (cAVF) are a rarity. Our case reports a cAVF between the innominate vessels post insertion of a tunneled hemo-dialysis central venous catheter (HD-CVC) via left internal jugular vein (IJV) in a 43-year-old female. She presented with progressive swelling in the left side of the neck and fullness of the left supra-clavicular fossa and supra-sternal notch with dyspnea upon exertion. High output cardiac failure was noted. Due to the impending rupture status at the catheter insertion site, surgery was expedited. The sternum was split and the communication between the arterial and venous system successfully ligated. Patient was discharged after a week. Literature search culminated in describing this first innominate arterio-venous fistula (AVF) post HD-CVC insertion case and its management.

The online version contains supplementary material available at 10.1007/s12055-025-01951-6.