Double layered autogenous vein graft patch reconstruction of the common carotid-internal jugular fistula caused by gunshot wound

Hereby we present a case with a common carotid-internal jugular fistula cau sed by gunshot wound. The patient was a 32-year old male who had an entranc e hole of a bullet on his right anterior cervical area, at the C-4 level wi th a hematoma surrounding it. The exit hole could be detected at the sublin gual area. By palpation a thrill and on auscultation a souffle was noted. N either crepitation, nor any neurologic deficit or any symptom of Horner's s yndrome was present. The emergency digital subtraction angiography (DSA) sh owed a fistulisation to internal jugular vein (IJV) approximately 0.5 cm be low the common carotid artery (CCA) bifurcation level. During the operation a hematoma and a false aneurysm was observed on the CCA. Also, proximally to the bifurcation, a communication of CCA with IJV was noted. The wall of the JJV was rather thinned and the size of the vessel had considerably enla rged. Following the evacuation of the hematoma and debridement, the integra tion of the artery was achieved by placing a double layered autogenous vein graft patch over the 0.5x1.5 cm defect. The 0.3x1.5 cm defect laterally ov er the IJV was primarily sutured. The patient was discharged on the fifth d ay. The control DSA taken on the twelfth day showed a perfect integration o f the vessels. We considered the case noticeable due to its rather rare inc idence and the double layered autogen vein patch graft reconstruction.