title: Late-onset congestive heart failure with multiple carotid-jugular fistulae and pseudoaneurysm after penetration injury.
abstract: Trauma-acquired multiple arteriovenous fistulae with late-onset congestive heart failure has not been documented. We describe a 29-year-old man who presented with progressive congestive heart failure 25 years after a penetrating trauma to the left side of the neck. The neck duplex showed a large shunt between the carotid artery and internal jugular vein. Arteriography showed three high-flow arteriovenous fistulae between these two vessels. Magnetic resonance angiography (MRA) showed a carotid pseudoaneurysm originating from three different loci of the carotid artery with a large aneurysm-venous communication between the pseudoaneurysm and the internal jugular vein. Reconstruction of contrast MRA showed three different arteriovenous fistulae, leading to the decision to perform aneurysmectomy, carotid artery repair and jugular vein patch angioplasty. The favorable outcome of this case illustrates that surgery is a reasonable alternative when an endovascular approach is not feasible in patients with trauma-acquired arteriovenous fistulae.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Medical Center, 138 Sheng Li Road, Tainan 704, Taiwan.
authors.forename: Ju-Yi
authors.initials: JY
authors.lastname: Chen
authors.forename: Shih-Hung
authors.initials: SH
authors.lastname: Chan
authors.forename: Li-Jen
authors.initials: LJ
authors.lastname: Lin
authors.forename: Chwan-Yau
authors.initials: CY
authors.lastname: Luo
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D020212:Carotid Artery Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007601:Jugular Veins / Q000293:injuries*; D018810:Magnetic Resonance Angiography; D008297:Male; D019838:Neck Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D015599:Trauma Severity Indices; D018616:Ultrasonography, Doppler, Duplex; D014656:Vascular Surgical Procedures; D014950:Wounds, Penetrating / Q000150:complications* / Q000175:diagnosis / Q000601:surgery