Circulatory Dynamics in the Presence of Carotid-jugular Fistula: Effects of Repair after Twelve Years' Patency.

THE collateral circulation that develops invariably in the vicinity of a systemic arteriovenous fistula has impressed generations of surgeons who have treated these lesions. Investigators in various surgical modalities have sought to apply this principle to enhance the blood supply of specific regional tissue. The most successful application to date has been the creation of femoral arteriovenous fistulas in children with shortened atrophic limbs, by the technic of Janes and Jennings.' Chatterjee and Warren 2 are investigating the effect of internal mammary arteriovenous fistulas on the coronary circulation. The concept of arterialization of the cerebral venous system to augment cerebral blood supply was introduced by Sciaroni3 in 1948. Beck and associates 4 modified Sciaroni's procedure of cross anastomosis and created sideto-side fistulas between the right internal jugular vein and the common carotid artery, with central ligation of the vein. The procedure was directed at the entities of organic brain disease, especially juvenile epilepsy and mental retardation. On the thesis that such lesions were characterized by gliosis of brain cells, it was anticipated that additional blood flow might penetrate the scar tissue and reactivate such cells. From 1949 to 1953, 363 patients in the United States and Europe were reported in whom carotid-jugular fistulas were produced.5-16 On the basis of this accumulated experience, the procedure was deemed without permanent value, and no further cases have been reported. Complications in the sev-