Article Figures & Data
Figures
- Fig 1.
Schematic representation of a vertebral arteriovenous fistula with steal phenomenon. Arrows represent blood-flow direction. A, Blood flow from both vertebral arteries is directed to the fistula site (double thin arrows). B, Trapping technique with positioning of detachable balloons (arrowheads) proximal and distal to the arteriovenous communication re-establishes normal flow through the basilar artery.
- Fig 2.
Traumatic arteriovenous fistula caused by detonation with propelled metal fragments (asterisks) penetrating the neck. A, Left vertebral arteriovenous fistula is identified with both ascending and descending venous drainage. B, There is steal phenomenon represented by filling of the fistula through the right vertebral artery. C, Fistula trapping has been performed with proximal (arrows) and distal (circle) balloon detachment. Note occlusion of the fistula with re-establishment of normal flow in the right vertebral artery.
- Fig 3.
Right vertebral arteriovenous fistula after a stab wound injury of the neck. A, Prominent ascending and descending venous drainage with the presence of pseudoaneurysm (arrow) is noted. B, Uncovered stent deployment with coiling (arrowheads) was performed. There is partial occlusion of the pseudoaneurysm and reduction in venous drainage in the immediate postreatment angiographic images. C, Angiographic control image 18 months after treatment shows normal flow through the right vertebral artery without evidence of fistula or pseudoaneurysm. D, Reconstructive endovascular approach by using a stent (double arrows) and coils (arrowhead) was accomplished. E, Transverse T1-weighted MR image demonstrates the right vertebral AVF compressing the cervical spinal cord (arrow). F, MR control image 18 months after treatment shows AVF thrombosis (arrow) and patency of the right vertebral artery (arrowhead).
Tables
- Table 1:
Angiographic and clinical results after endovascular treatment of traumatic lesions of the vertebral artery
Patient No. Sex/Age (yr) Clinical Presentation Cause Topography Treatment Occlusion Grade Clinical Outcome 1 M/18 Neck bruit Gunshot Above C2, left Coiling Total Asymptomatic 2 M/28 Neck bruit Gunshot C5-C2, left Balloon occlusion (trapping technique) Total Asymptomatic 3 M/18 Neck bruit, cephalgia Gunshot Below C5, left Balloon occlusion (parent artery sacrifice) Total Asymptomatic 4 M/26 Spinal cord symptoms Stab wound Below C5, right Stent, coils, n-butyl cyanoacrylate Partial* Asymptomatic 5 M/35 Neck bruit Gunshot Below C5, left Balloon occlusion (trapping technique) Total Asymptomatic 6 M/27 Neck bruit Gunshot C5-C2, right Balloon occlusion (trapping technique) Total Asymptomatic 7 M/35 Neck bruit, cephalgia Gunshot Above C2, left Ballon occlusion and coiling of the AVF Partial* Asymptomatic 8 M/42 Neck bruit Gunshot Above C2, left Coiling Total Asymptomatic 9 M/26 Brain infarcts Stab wound Below C5, right Balloon occlusion (parent artery sacrifice) Total Partial improvement 10 M/36 Neck bruit Stab wound C5-C2, left Balloon occlusion (parent artery sacrifice) Total Asymptomatic 11 F/11 Radiculopathy Jugular catheter C5-C2, right Balloon occlusion (trapping technique) Total Asymptomatic 12 M/19 Neck bruit Gunshot Below C5, right Balloon occlusion (trapping technique) Total Asymptomatic 13 F/21 Neck bruit Gunshot Above C2, right Balloon occlusion (trapping technique) Total Asymptomatic 14 M/25 Neck bruit Stab wound C5-C2, right Spontaneous occlusion Total Asymptomatic 15 M/23 Tinnitus Gunshot Above C2, left Balloon occlusion (trapping technique) Total Asymptomatic 16 F/43 Neck bruit Stab wound C5-C2, right Balloon occlusion (parent artery sacrifice) Total Asymptomatic 17 F/49 Bruit, arm weakness, SAH Detonation C5-C2, left Balloon occlusion (trapping technique) Total Asymptomatic 18 M/27 Neck bruit Gunshot Above C2, left Balloon occlusion of the AVF Total Asymptomatic Note:—SAH indicates subarachnoid hemorrhage; AVF, arteriovenous fistula.
* Initially partial angiographic occlusion, total occlusion during follow-up.
Patient No. Type Arterial feeders Venous Drainage 1 AVF + pseudoaneurysm Left vertebral, ECA Vertebral vein, IJV; Asc, Desc 2 AVF Left vertebral Epidural plexus; Asc, Desc 3 AVF Left vertebral Vertebral vein; Desc 4 AVF + pseudoaneurysm Right vertebral Perimedullary plexus; Asc, Desc 5 AVF + pseudoaneurysm Left vertebral IJV; Asc, Desc 6 AVF Right vertebral Vertebral vein, IJV; Desc 7 AVF + pseudoaneurysm Left vertebral, ECA IJV; Asc 8 AVF + pseudoaneurysm Left vertebral Vertebral vein, IJV; Asc, Desc 9 Pseudoaneurysm Right vertebral None 10 AVF + pseudoaneurysm Left vertebral, muscular branch Vertebral vein; Asc 11 Pseudoaneurysm Right vertebral None 12 AVF Right vertebral Vertebral vein, IJV, epidural plexus; Desc 13 AVF Right vertebral IJV, perimedullary plexus; Asc, Desc 14 AVF Right vertebral Vertebral vein; Desc 15 AVF Left vertebral Vertebral vein; Asc, Desc 16 AVF Right vertebral, thyrocervical trunk Perimedullary plexus; Asc, Desc 17 AVF Left vertebral IJV, epidural plexus; Desc 18 AVF + pseudoaneurysm Left vertebral Perimedullary plexus, dural sinus; Asc Note:—ECA indicates external carotid artery; IJV, internal jugular vein; Asc, ascending; Desc, Descending; AVF, arteriovenous fistula.
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