Color duplex evaluation of an iatrogenic internal jugular-common carotid artery fistula

A 66-year-old female sustained an iatrogenic internal jugular vein to common carotid artery fistula during attempted percutaneous right internal jugular vein central venous access. A proximally based common carotid artery intimal flap occurred at the time of initial injury with resultant hemiparetic stroke secondary to atheroembolic debris. Color duplex scan and angiography accurately identified the arteriovenous fistula. However, angiography did not demonstrate the intimal flap seen on duplex scan and documented at surgery. Duplex scan was diagnostic and provided the definitive data in planning appropriate operative repair of this injury.