title: Management of an arteriovenous fistula with two nidus between the inferior alveolar artery and the external jugular vein.
abstract: BACKGROUND
  Cervical arteriovenous fistulas are rare forms of head and neck tumors.
  
  
  METHODS
  We describe the case of a patient with an extensive fistula between the right inferior alveolar artery and the external jugular vein. The disorder had been diagnosed 30 years earlier and the patient had been followed clinically and radiologically ever since. The patient developed progressive cardiac failure and surgery was required when arteriovenous fistula expansion was found after 2 failed attempts at embolization.
  
  
  RESULTS
  During resection of the arteriovenous fistula, a second nidus in contact with the mandible was discovered, which excision led to severe hemorrhage and mandibulectomy was performed to obtain hemostasis.
  
  
  CONCLUSIONS
  This rare case was a true surgical challenge because the patient's life was at stake. In such difficult cases, preoperative assessment is essential because of the risk of major bleeding. Finally, CT angiogram reconstructions are undeniably helpful in elaborating the surgical treatment plan.
authors.affiliation: ENT Unit, Edouard Herriot Universitary Hospital, Lyon, France. guillaume.buiret@chu-lyon.fr
authors.forename: Guillaume
authors.initials: G
authors.lastname: Buiret
authors.forename: Patrick
authors.initials: P
authors.lastname: Feugier
authors.forename: Isabelle
authors.initials: I
authors.lastname: Plouin-Gaudon
authors.forename: François
authors.initials: F
authors.lastname: Disant
authors.forename: Frédéric
authors.initials: F
authors.lastname: Faure
mesh_terms: D001164:Arteriovenous Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D004621:Embolization, Therapeutic; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008334:Mandible / Q000098:blood supply*; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure