Vertebro-vertebral Arteriovenous Fistula Research Articles

Case Report: Vertebro-vertebral arteriovenous fistula showing symptoms mimicking ALS: Diagnostic imaging supports accurate differentiation between ALS and mimicking conditions

We report a rare case of a vertebro-vertebral arteriovenous fistula (VVAVF) manifesting as amyotrophic lateral sclerosis (ALS). A 76-year-old female patient presented with progressive weakness, muscle atrophy, fasciculation, and preserved deep tendon reflexes in the right upper limb. Electrophysiological testing showed lower motor neuron dysfunction. The patient was suspected to have ALS, but cervical magnetic resonance imaging (MRI) revealed enlarged blood vessels in the spinal canal, which compressed the cervical spinal cord and nerve roots. Angiography showed a shunt from the right vertebral artery to the right intervertebral vein and the vertebral venous plexus; therefore, the patient was diagnosed with VVAVF. Transarterial embolization was performed to obliterate the shunt, and weakness in the patient’s right upper limb subsequently improved. It is worth considering VVAVF as a differential diagnosis of ALS-like diseases.

Case Report: Vertebro-vertebral arteriovenous fistula showing symptoms mimicking ALS: Diagnostic imaging supports accurate differentiation between ALS and mimicking conditions

We report a rare case of a vertebro-vertebral arteriovenous fistula (VVAVF) manifesting as amyotrophic lateral sclerosis (ALS). A 76-year-old female patient presented with progressive weakness, muscle atrophy, fasciculation, and preserved deep tendon reflexes in the right upper limb. Electrophysiological testing showed lower motor neuron dysfunction. The patient was suspected to have ALS, but cervical magnetic resonance imaging (MRI) revealed enlarged blood vessels in the spinal canal, which compressed the cervical spinal cord and nerve roots. Angiography showed a shunt from the right vertebral artery to the right intervertebral vein and the vertebral venous plexus; therefore, the patient was diagnosed with VVAVF. Transarterial embolization was performed to obliterate the shunt, and weakness in the patient’s right upper limb subsequently improved. It is worth considering VVAVF as a differential diagnosis of ALS-like diseases.

Rescue embolization with direct coil delivery from dual-lumen balloon microcatheter.

Balloon microcatheters are widely used for endovascular treatment. However, no reports on direct coil embolization from dual-lumen balloon microcatheters are available in the literature. This report is the first description of direct coil embolization using this type of balloon microcatheter for looming bleeding emergencies. This retrospective review demonstrates the indications and advantages of coil embolization from an inflated balloon catheter to reduce blood loss and simultaneously occlude bleeding. Five patients who underwent emergency endovascular treatment using coil embolization directly delivered from a dual-lumen balloon were identified. Etiologies included vertebro-vertebral arteriovenous fistula, ruptured vertebral artery dissecting aneurysm, vertebral artery injury during cervical spinal operation, and failed stent retrieval procedures for acute infarction. Complete hemostasis was achieved with all procedures. Our experience demonstrates the feasibility of direct coil embolization by using a dual-lumen balloon to rapidly halt bleeding in some rare emergency situations, which may save lives.

A Case of Lower Cervical Vertebro-vertebral Arteriovenous Fistula with High-flow Shunt

A Case of Lower Cervical Vertebro-vertebral Arteriovenous Fistula with High-flow Shunt

Spontaneous resolution of a non-traumatic vertebro-vertebral arteriovenous fistula in a paediatric patient

We report the case of a 10 year old male who presented with right sided tinnitus and a pulsatile neck mass. MRI of the neck demonstrated a vertebro-vertebral arteriovenous fistula (VAVF), with supply from the right vertebral artery and drainage into a paraspinal venous plexus at C1/2. Endovascular treatment would have necessitated vertebral artery sacrifice with significant risk of complication, therefore a conservative approach was adopted; the patient was lost to follow up but presented 5 years later with complete resolution. We therefore advocate a role for conservative management when treatment would pose undue risk.

A Case of Vertebro-vertebral Arteriovenous Fistula Clinically Diagnosed as Segmental Arterial Mediolysis Complicated by Celiac Artery Aneurysm Suspected in a State of Impending Rupture

A Case of Vertebro-vertebral Arteriovenous Fistula Clinically Diagnosed as Segmental Arterial Mediolysis Complicated by Celiac Artery Aneurysm Suspected in a State of Impending Rupture

Endovascular Treatment of Vertebro-Vertebral Arteriovenous Fistula

This report describes endovascular approaches for occlusion of vertebro-vertebral arteriovenous fistula (VV-AVF) in a series of three cases and a review of the literature. Complete neuroimaging assessment, including CT, MR and DSA was performed in three patients (two female, one male) with VV-AVF. Based on DSA findings, the VV-AVF were occluded by endovascular positioning of detachable balloons (case 1), coils (case 2), or a combination of both (case 3) with parent artery patency in two out of three cases. In this small series, endovascular techniques for occlusion of VV-AVF were safe and effective methods of treatment. To date, there are no guidelines on the best treatment for VV-AVF. Detachable balloons, endovascular coiling, combined embolization procedures could all be considered well-tolerated treatments.

Endovascular treatment of high-flow cervical direct vertebro-vertebral arteriovenous fistula with detachable coils and Onyx liquid embolic agent

We report the first experience in the treatment of high-flow cervical direct vertebro-vertebral arteriovenous fistula (VVAVF), which was successfully occluded with detachable coils and Onyx through transarterial approach. A 20-year-old female presented with 2-month history of paresis of bilateral extremities. Magnetic resonance imaging (MRI) showed that the dilated ventral epidural veins as well as the dilated left paraspinal veins compressed the spinal cord. Digital subtraction angiography demonstrated high-flow VVAVF between the left vertebral artery (VA) and the surrounding venous plexus at the C3 cervical level. The fistulas were also fed by backward flow from the right VA and left ascending cervical arteries. Transarterial endovascular treatment was performed by using detachable coils and Onyx; immediate angiographic obliteration was achieved. VVAVF-related symptoms resolved gradually, and there was complete neurologic recovery without clinical consequences on clinical follow-up. The fistulas remained closed, as ascertained by 2-month follow-up computed tomography angiography and MRI. No new neurological deficit related to the procedure was detected. The endovascular treatment of direct VVAVF with combination of detachable coils and Onyx is feasible, safe, and highly effective with low morbidity and mortality.

Traumatic Vertebro-vertebral Arteriovenous Fistula Manifesting as Radiculopathy -Case Report-

A 58-year-old man presented with a traumatic vertebro-vertebral arteriovenous fistula (VVAVF) after attempting suicide by thrusting scissors into his right anterior cervical region. Two months later he noticed weakness and numbness of the right upper extremity. Examination revealed bruit in the right neck, no cranial nerve palsy, and weakness of the right deltoid and biceps muscles. Hypalgesia and hypesthesia were noted in the right C5 and C6 dermatomes. Magnetic resonance imaging demonstrated a mass lesion on the right ventral aspect of the spinal canal from C2 to C7. Right vertebral artery angiography showed a pseudoaneurysm of the right vertebral artery and a high-flow arteriovenous fistula between the right vertebral artery and vein. The right vertebral artery was occluded with detachable coils because the fistula showed high blood flow and the right posterior inferior cerebellar artery was well opacified from the left vertebral artery. This procedure resulted in complete obliteration of the arteriovenous fistula. The preoperative motor and sensory symptoms improved. Endovascular treatment by coil embolization was effective in our patient with traumatic VVAVF.

Iatrogenic Vertebro-vertebral Arteriovenous Fistula Associated with Internal Jugular Vein Catheterization - A case report -

Iatrogenic vertebro-vertebral arteriovenous fistula (AVF) is an uncommon complication resulting from various procedures such as central venous catheter insertion. The incidence may be underestimated since the diagnosis is not easy because of its rarity. A central venous catheterization via the internal jugular vein was attempted in a 43-year-old female who presented for intracranial aneurysmal clipping under general anesthesia. Inadvertent arterial puncture was recognized as pulsatile arterial blood flow through the needle. The needle was removed and local compression was applied to the puncture site. The catheter was inserted via the right femoral vein. After surgery, the patient recovered from anesthesia without any complications. On postoperative day 5, thrill and bruit on the right side of the neck were noted on physical examination. Angiography confirmed vertebro-vertebral AVF, which was successfully obliterated with a stent 3 months later.

Diagnostic et traitement des fistules vertébrovertébrales: Revue de la littérature : à propos de 8 observations

Vertebrovertebral Arteriovenous Fistula (V.V.A.V.F.) is a relatively rare entity. It may be an incidental finding or be detected in patients presenting with pulsatile tinnitus, cervical bruit, or vertebro-basilar insufficiency. It can be spontaneous but it most frequently is post-traumatic in etiology. The authors report 8 patients, 4 women and 4 men aged between 20 to 77 years, with 4 post-traumatic V.V.A.V.F. and 4 spontaneous V.V.A.V.F. that were seen over a 15 year period. Imaging work-up included Doppler US (n=4), MRI 9n=3) and angiography (n=8). Seven of 8 patients were treated successfully using an endovascular technique (5 with balloon occlusion, 1 with coil embolization and 1 using a mechanical maneuver), without complication or recurrence, except in one case. We compare our results with published reports from the literature and review the underlying pathology and management strategies of V.V.A.V.F.

Spontaneous Vertebrovertebral Arteriovenous Fistulae Clinical Features, Angioarchitecture and Management of Twelve Patients

Spontaneous vertebrovertebral arteriovenous fistula (SVVAVF) is a rare condition which often presents as a bruit. We reviewed the clinical and imaging records of 12 patients with 13 SVVAVF fistulae who were managed at our institution over the last 14 years. Two patients had predisposing conditions, neurofibromatosis in one and Ehlers-Danlos syndrome in the other. Nine of the patients presented with a bruit; one patient presented with a myelopathy and one with congestive cardiac failure. Six of the 13 fistulae were at Cl and five of these six were children. 1n seven of the fistulae there was retrograde flow in the distal vertebral artery. Eight patients underwent endovascular treatment. Six required both contralateral and ipsilateral vertebral artery approaches. Coils (two patients), balloons (three patients), or a combination of agents including liquid adhesives (three patients) were used. Preservation of the vertebral artery was possible in three of the eight patients. Angiographic obliteration was obtained in all eight patients. There were no significant procedure-related complications. Embolisation is the primary treatment of SVV AVF and can be performed successfully with low morbidity. Preservation of the vertebral artery, although desired, is often not possible.

Spontaneous Vertebrovertebral Arteriovenous Fistula Treated by Steel Coil Embolization: Case Report

The authors report 1 case of a spontaneous vertebrovertebral arteriovenous fistula in a fifty-seven-year-old woman. Embolization with a steel coil resulted in complete occlusion of the fistula while maintaining vertebral artery patency.