%0 Journal Article
%T Acquired Carotid-Jugular Fistula: Its Changing History and Management
%A Claudio Caldarelli
%A Marco Biricotti
%A Gabriele Materazzi
%A Claudio Spinelli
%A Roberto Spisni
%J ISRN Vascular Medicine
%D 2013
%R 10.1155/2013/320241
%X Purpose. To highlight the changes that have come about in recent years in the etiology, diagnosis, and treatment of acquired carotid-jugular fistulas. Methods. We present a review of the literature on acquired carotid-jugular fistulas (CJFs), which includes studies from World Wars I and II up to today and a retrospective analysis of the lesion reports published in the period 2000¨C2012, with an update of Talwar's table. The case study of one patient suffering from an untreated, long-standing CJF recently treated by us is also presented and included in the updated table. Results. Thanks to early treatment of acute lesions by reconstructive and endovascular surgery, incidence of posttraumatic carotid-jugular fistulas is decreasing, while the number of iatrogenic ones due to medical advances is concomitantly increasing, specifically because of the ever more widespread use of central venous catheters for venous pressure monitoring, parenteral nutrition, and hemodialysis. Conclusion. Although such lesions seem destined to diminish in the future thanks to the above-mentioned diagnostic and therapeutic advances, the increasing number of internal jugular vein catheterizations performed worldwide implies that physicians will still be dealing with carotid-jugular fistulas for many years to come. 1. Introduction and General Considerations Arteriovenous fistulas (AVFs) can be either congenital or acquired. Congenital AVFs are less common and frequently have numerous small arteriovenous connections, while acquired fistulas consist of a single larger connection, and they are most frequently the result of penetrating trauma or iatrogenic action (IJV catheter placements). Acquired AVFs have often traumatic origin, and war and after-war periods have offered the major contribution to their knowledge [1¨C6]. These lesions can involve all the body districts arteries with prevalence in lower extremities (49%). Superior members localizations follow for 16¨C26%, head and neck for 3 and 29%, respectively, and chest for 2-3% [7, 8]. Acquired AVFs involving major vessels in the head and neck are most frequently caused by penetrating trauma (gunshot injury and stab wounds) or by internal jugular vein catheterization for central venous pressure monitoring, parenteral nutrition or vascular access for hemodialysis, nowadays increasing in the developing countries [9]. The epidemiology of traumatic, noniatrogenic carotid-jugular fistulas (CJFs) depends on the varying incidence of cervical vascular trauma which was 10.7% of all injuries in WW I, 0.4% in WW II, 3.6% in the Korean War, and
%U http://www.hindawi.com/journals/isrn.vascular.medicine/2013/320241/