A Rare Cause of Difficult Catheterization to the Left Brachiocephalic Vein during Transfemoral Transvenous Embolization

OBJECTIVE: We experienced a case of difficult catheterization to the left brachiocephalic vein (LBCV) during transfemoral transvenous embolization for traumatic carotid-cavernous fistula. We discussed the cause of this phenomenon. CASE PRESENTATION: A 78-year-old woman with a traumatic carotid-cavernous fistula was treated with combined transarterial and transvenous embolization; however, catheterization to the LBCV was very difficult. A balloon guiding catheter (BGC) already placed in the left common carotid artery (LCCA) caused displacement of the LCCA and further compression of the originally stenotic LBCV. A CT investigation of 104 cases of neuroendovascular treatment in our hospital revealed that the distance between the ventral bones and the dorsal arteries sandwiching the LBCV was significantly negatively correlated with age (r = −0.41, p = 0.000020). Aging and arteriosclerotic change are possibly related to the LBCV stenosis. CONCLUSION: When catheterization to the LBCV is difficult during transfemoral transvenous embolization, not only the presence of anatomical variations and stenosis or occlusion of LBCV itself but also compression from surrounding structures should be considered, especially in elderly patients. In rare cases, a catheter inserted in an adjacent artery may cause further compression of the LBCV.