Vertebral Arteriovenous Fistula: An Unusual Complication of Swan-Ganz Catheter Insertion

The leading causes of trauma to the major craniocerebral vessels include penetrating and non penetrating trauma [1, 2]. Because the vertebral artery is confined to the incom-plete bony canal formed by the successive foramina in the transverse processes of the upper cervical vertebrae, it is less susceptible to penetrating injury than is the carotid artery [2]. A review of the literature has uncovered no previous ex-amples of pseudoaneurysm or arteriovenous fistula specifi-cally involving the vertebral artery as a complication of per-cutaneous internal jugular vein cannulation [3, 4]. We describe Fig. 1.-Left posterior oblique (A) and lateral (8) subtraction films from right ver-tebral arteriography demonstrate 5 x 9 mm vertebral pseudoaneurysm (small ar-rowheads) and arteriovenous fistula (curved arrow). Rapid filling of numerous adjacent paravertebral veins (large arrow-heads)