Subclavian-superior vena caval arteriovenous fistula.

A case is described of an arteriovenous fistula between the right subclavian artery and right brachiocephalic trunk draining into the superior vena cava. This was associated with an intermittent left hemiparesis, visual disturbances and an expressive dysphasia. The operative procedure is outlined and the possible aetiology discussed. An arteriovenous fistula, a direct communication between an artery and a vein which bypasses the capillary network, may be congenital or acquired. Congenital fistulae are more commonly diffuse vascular overgrowths, localised aneurysmal varies or malformations within viscera. Acquired fistulae may follow injury, operation or disease.’ Small peripheral fistulae may close spontaneously, occasionally following thrombophlebitis or angiography2 but larger communications are often associated with complications including deprivation of distal arterial blood, heart failure and endarteritis. Congenital arteriovenous fistulae in the neck are rare and this is believed to be the first reported case between the subclavian artery and the superior