CTICasesIatrogenic Brachiocephalic Artery to Innominate Vein Fistula
Imaging findings
Aortography and CT angiography demonstrate a high-flow arteriovenous fistula between the brachiocephalic artery and the left innominate vein. The left innominate vein is dilated and irregular, showing immediate and dense opacification along with multiple large venous collaterals in the neck and upper chest.
Key takeaways
High-flow arteriovenous fistulas involving the thoracic great vessels are a rare, serious complication of pacemaker implantation or lead revision. These are typically caused by mechanical trauma during vascular access or lead manipulation, and prompt imaging with CT angiography is required to guide endovascular intervention.
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