Endovascular management of iatrogenic carotid-jugular fistula presenting as congestive heart failure

Carotid-jugular arteriovenous fistula (C-J AVF) after inadvertent carotid puncture during internal jugular vein puncture is a rare entity. Previously, majority of reported cases of CJAVF were identified during inadvertent arterial puncture and managed as emergency. We report a delayed presentation of congestive cardiac failure following multiple attempts at securing an internal jugular venous access for dialysis 3 months prior to diagnosis. Carotid-jugular fistula was identified during workup and was successfully treated by endovascular technique with a covered stent.