Deconstructive repair of a traumatic vertebrovertebral arteriovenous fistula via a contralateral endovascular approach

• Published in: Journal of cerebrovascular and endovascular neurosurgery Vol. 24; no. 3; pp. 291 - 296
• Main Authors: Nageshwaran, Sathiji K., Deng, Francis, Regenhardt, Robert W., Das, Alvin S., Alotaibi, Naif M., Patel, Aman B., Stapleton, Christopher J.
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Cerebrovascular Surgeons and Korean NeuroEndovascular Society 01.09.2022; 대한뇌혈관외과학회
• Subjects: Case Report; 신경외과학; Vertebral artery; Arteriovenous fistula; Fistula; Endovascular; Endovascular procedures
• ISSN: 2234-8565; 2287-3139
• DOI: 10.7461/jcen.2022.E2021.10.002

Vertebrovertebral arteriovenous fistulas (VVAVFs) are rare entities that lack consensus guidelines for their management. Our case describes the successful treatment of a traumatic VVAVF via a contralateral deconstructive endovascular approach. A 64-year-old female presented following a traumatic fall. Computed tomography angiogram highlighted a 2 cm pseudoaneurysm of the right vertebral artery (VA) with epidural contrast enhancement and a hematoma with flow voids within the epidural space. Digital subtraction angiography showed a VVAVF at C2-3 with retrograde filling of the distal right VA. Having undergone several unsuccessful passes of the proximal dissection flap in the right VA, the patient underwent a contralateral deconstructive approach with correction of the VVAVF without complication. The remaining feeding branches had occluded after 1 week. The patient made a complete recovery without neurological sequelae at 3-month follow-up.