A 77-year-old woman was diagnosed with meningioma on the left frontal cerebral falx and scheduled for tumorectomy in the supine position. Under general anesthesia, her right lower extremity was abducted and externally rotated in the supine position for central venous catheterization to the right femoral vein to prepare for intraoperative bleeding. Prescanning for catheterization with ultrasound (SonoSite M – Turbo®, FUJIFILM©) using linear probe was performed. Although the femoral artery and femoral vein did not overlap at the inguinal ligament level, both vessels overlapped toward the periphery. An ultrasound probe was placed 1 cm peripheral from the inguinal ligament, and the skin insertion point of the needle was 3 cm peripheral from the inguinal ligament (Fig. 1). The puncture was performed once using real-time ultrasound guidance (short axis view/out-of-plane approach), and where the needle tip punctured, the target vein was visualized. A central venous double lumen catheter (SMAC Plus®, COVIDIEN™) was inserted smoothly using the Seldinger technique, and reversal of the venous blood was observed.
When the central venous catheter was removed 6 days after the operation, arterial bleeding was observed. The bleeding stopped by compression with hands. Color Doppler ultrasound and contrast computed tomography detected arteriovenous fistula between the right femoral artery and femoral vein 8 days after the operation (Fig. 2). Angioplasty was performed 15 days after the operation.