Voice Matters: Late Presentation of an Iatrogenic Vertebral Arteriovenous Fistula after Liver Transplantation in Early Childhood with Successful Endovascular Treatment

Abstract

Central venous cannulation is known to be a frequent cause of iatrogenic morbidity. Children are at particular risk for anatomical reasons, especially those who require complex surgical interventions because central venous access is frequently needed before, during, and after the procedure. Immediate complications, such as failure of cannulation, pneumothorax, arterial puncture, and nerve injury, are well documented. Traumatic vertebral artery pseudoaneurysms and arteriovenous fistulas are however uncommon lesions in children. Whilst surgical fistula closure has been traditionally advocated as first-line treatment, endovascular noninvasive techniques are becoming increasingly available in childhood. We report the successful endovascular treatment of a 14-year-old girl with a large vertebro-subclavian fistula 13 years after orthotopic liver transplantation.