Acute Formation of a Blunt Trauma-induced Vertebral Artery Arteriovenous Fistula Treated with Endovascular Occlusion of Vertebral Artery.

Michael Young,Ajeet Gordhan,Ryan Johnson

doi:10.7759/cureus.5801

Abstract

Fistulous cerebrovascular injuries can occur spontaneously, iatrogenically following surgical procedures, or can result as a consequence of penetrating trauma. To our knowledge, this is only the second reported case of blunt-trauma induced cervical vertebral artery arteriovenous fistula (AVF) formation in a 55-year-old male. This was successfully occluded with N-butyl cyanoacrylate (NBCA) embolization of the recipient vein and endovascular coil ligation of the vertebral artery.

Highlights

Arteriovenous fistulas (AVF) of the vertebral artery are rare vascular malformations of the spinal vasculature that can present after cervical spine surgery, central venous catheterization, chiropractic manipulations, diagnostic cerebral angiography, percutaneous nerve blocks, radiation therapy, penetrating traumatic injury, or even more rarely blunt traumatic injury
We present a case of a 55-year-old male who sustained an AVF of the vertebral artery after a blunt traumatic mechanism
Paramedics reported a Glasgow coma score (GCS) of 3 in the field and he was intubated for airway protection

Summary

Introduction

Arteriovenous fistulas (AVF) of the vertebral artery are rare vascular malformations of the spinal vasculature that can present after cervical spine surgery, central venous catheterization, chiropractic manipulations, diagnostic cerebral angiography, percutaneous nerve blocks, radiation therapy, penetrating traumatic injury, or even more rarely blunt traumatic injury. We present a case of a 55-year-old male who sustained an AVF of the vertebral artery after a blunt traumatic mechanism. Ligation of the left vertebral artery was accomplished with the deployment of nine Target 360 detachable coils (Stryker, Kalamazoo, MI, USA), and two Tornado embolization coils (Cook Medical, Bloomington, IN, USA; Figure 4A). This resulted in complete angiographic obliteration of the left vertebral artery with adequate flow through the non-dominant right vertebral artery, basilar artery and the left posterior inferior cerebellar artery (Figure 4B). On post-procedure day one, the patient improved neurologically, demonstrated by an improvement in GCS from 3T to 8T He was localizing to noxious stimuli with the left upper extremity and withdrawing to noxious stimuli in the left lower extremity. He was sent to a long-term acute care facility for rehabilitation on post-interventional procedure day 13

Discussion

Conclusions

Disclosures

11. Aronson NI