Summary about Disease
A brachiocephalic fistula (BCF) is an abnormal connection between the brachiocephalic artery (also known as the innominate artery) and a nearby vein, typically the brachiocephalic vein. This is a relatively rare condition and is most often iatrogenic, meaning it's caused by a medical procedure or intervention. Due to high pressure arterial blood flow into the lower pressure venous system it can have significant hemodynamic consequences.
Symptoms
Symptoms can vary depending on the size of the fistula and the amount of blood shunted from the artery to the vein. Possible symptoms include:
Swelling in the neck or upper chest
Pulsatile mass in the neck
Bruit (an abnormal whooshing sound) heard with a stethoscope over the fistula
Shortness of breath
Chest pain
Headache
Arm swelling or pain
Heart failure (in severe cases due to increased cardiac workload)
Distended neck veins
Causes
The most common cause of a brachiocephalic fistula is iatrogenic injury, most often related to:
Central venous catheter placement or removal
Pacemaker or implantable cardioverter-defibrillator (ICD) lead placement or removal
Trauma (rare)
Medicine Used
There are no medicines to cure or directly treat a brachiocephalic fistula. Treatment usually involves surgical or endovascular intervention. Medications might be used to manage symptoms, such as:
Diuretics for heart failure
Pain relievers for pain
Anticoagulants or antiplatelet medications may be used in some circumstances to prevent thrombosis, but are often avoided due to bleeding risk around the fistula.
Is Communicable
No, a brachiocephalic fistula is not communicable. It is not caused by an infectious agent and cannot be spread from person to person.
Precautions
Precautions generally relate to preventing the initial injury that leads to the fistula, such as:
Careful technique during central venous catheter placement
Use of ultrasound guidance during central line placement
Careful surgical technique during pacemaker/ICD lead placement or removal.
If a fistula is diagnosed, avoiding activities that could increase blood flow to the affected area might be advised, although this is determined on a case-by-case basis.
How long does an outbreak last?
There is no "outbreak" associated with brachiocephalic fistula. The condition exists from the time the fistula is formed until it is treated or resolves spontaneously (which is rare). Symptoms may worsen over time if the fistula is not addressed.
How is it diagnosed?
Diagnosis typically involves:
Physical examination: Identifying a pulsatile mass or bruit in the neck.
Imaging studies:
Duplex Ultrasound: Can visualize the fistula and assess blood flow.
CT angiography (CTA): Provides detailed anatomical information about the fistula and surrounding vessels.
Magnetic resonance angiography (MRA): An alternative to CTA.
Angiography (conventional): Gold standard for diagnosis and can be used for endovascular treatment.
Venography: If venous involvement is not clear on other imaging.
Timeline of Symptoms
The timeline of symptoms depends on the size of the fistula and the rate of blood flow through it. Symptoms may:
Appear immediately after the inciting event (e.g., central line removal).
Develop gradually over days, weeks, or even months as the fistula enlarges and the shunt volume increases.
Be initially subtle and progress to more severe symptoms over time.
Important Considerations
Brachiocephalic fistulas can have significant hemodynamic consequences, potentially leading to heart failure.
Early diagnosis and treatment are essential to prevent complications.
Treatment options include surgical repair or endovascular techniques (e.g., coil embolization, stent-graft placement).
The choice of treatment depends on the size and location of the fistula, as well as the patient's overall health.
Prompt referral to a vascular surgeon or interventional radiologist is crucial.