No abstract

Background: Spontaneous regression of huge vertebral arteriovenous fistula (AV fistulas) due to acupuncture procedure is a rare phenomenon. The clinical presentations, management, prognosis of this type arteriovenous fistula has been rarely reported. In addition, we exclusively analyzed the possible reasons for its spontaneous regression.Case presentation: A 57-year-old Chinese woman presented with a 2-month history of progressively worsening headache and high-pitched tinnitus after acupuncture and massage in the neck and the left mastoid region. Later Digital Subtraction Angiography (DSA) confirmed the presence of arteriovenous fistulas at cervical 2-3 (C2-3) level, lying between the paravertebral venous plexus and the left vertebral artery. The patient had a background of hypertension, hypothyroidism and hysterectomy. The arteriovenous fistulas disappeared mysteriously, possibly because of the motion of the left vertebral artery and the compression of guide wire against the blood vessel wall. The patient recovered well following conservative treatment of taking atorvastatin calcium tablets (20mg/day), despite delayed recognition and invasive investigation.Conclusion: Adequate evaluation and standardized procedures with Doppler may minimize the associated risks while performing acupuncture. Early application of vascular examination should be considered in patients with typical high-pitched tinnitus and medical history associated with acupuncture treatment. Statins are effective in repairing the lining of blood vessels.