Endovascular and surgical approaches of iatrogenic vertebrovertebral arteriovenous fistula

Abstract

Vertebrovertebral arteriovenous fistula is an uncommon vascular disease with no clear management guidelines. It is most commonly caused by iatrogenic injury. We have presented the details of two iatrogenic cases and a review to discuss strategies for endovascular and surgical approaches. From the digital subtraction angiography findings, the vertebrovertebral arteriovenous fistulas were occluded by endovascular coil positioning (patient 1) and surgical ligation of the fistulas (patient 2). Although endovascular approaches are increasing in popularity and considered well-tolerated treatments, open surgical treatment is still reserved for the most complex cases and those not feasible for endovascular treatment.

Keywords: Endovascular surgery; Open surgery; Vertebrovertebral arteriovenous fistula.

Fig 1

A, Carotid ultrasound scan showing a fistula between the right vertebral artery (VA) and vein. B,C, Digital subtraction angiogram revealing multiple dilated serpiginous vessels surrounding the right VA and epidural venous plexus. D,E, Preoperative and postoperative computed tomography angiograms (CTAs) showing the diagnosis and confirming successful treatment.

Fig 2

A, Carotid ultrasound scan showing a large fistula between the right vertebral artery (VA) and vein. B, Preoperative computed tomography angiogram (CTA) showing the diagnosis of multiple oversized fistulas with significant tortuosity. C, Follow-up CTA at 3 months after the procedure demonstrating successful treatment.