Left brachiocephalic venous occlusion with spontaneous arteriovenous fistula presenting with severe edema in left upper extremity and face: A case report

Introduction and importance: The coexistence of central venous occlusion and arteriovenous fistulas (AVF) is rare among non-dialysis patients. Herein, we describe a case of left brachiocephalic venous occlusion with spontaneous AVF, presenting with severe edema in left upper extremity and face.

Case presentation: A 90-year-old woman presented to our hospital with gradually worsening edema in her left arm and face for eight years. Contrast-enhanced computed tomography revealed left brachiocephalic venous occlusion and severe edema in her left upper extremity and face. Computed tomography also revealed abundant collateral veins; thus, it seemed unnatural for severe edema to occur with such well-developed collateral pathways. Therefore, the presence of AVF was suspected. After careful re-examination of the patient, a continuous murmur was heard in the post-auricular region. Magnetic resonance imaging and angiogram revealed a dural AVF. Considering the patient's age and treatment difficulty for the dural AVF, we performed a stent insertion into the left brachiocephalic vein. After the procedure, edema in her left upper extremity and face improved dramatically.

Clinical discussion: In cases of persistent swelling of the upper extremities or face, there could be a factor that increases venous inflow. Therefore, any condition that may increase venous inflow must be aggressively investigated and therapeutic interventions should be applied to treat such conditions.

Conclusion: Central venous occlusion and AVF is a possible underlying cause for severe refractory edema in the upper extremity and face. Therefore, both AVF and brachiocephalic occlusion should be assessed for treatment indications under these conditions.