Combined endovascular and surgical treatment in vertebral arteriovenous fistula

Abstract

A 7-year-old girl with a right-sided congenital arteriovenous fistula in the neck was admitted with signs of cardial incompensation. Her fistula was fed from the right vertebral artery in antegrade as well as retrograde directions. A steal from the intracranial arteries was established. In addition, smaller feeding arteries from the neck were found. She was operated on with ligation of the right vertebral artery proximal to the fistula but the attempted ligation of the artery cranially to the fistula was unsuccessful. She was therefore embolized by the formation of a plug of platinum fiber coils in the upper right vertebral artery. Catheterization was performed from the left vertebral artery via the basilar artery. Persisting minor feeders to the fistula from cervical arteries were embolized in a second session. Finally, surgical extirpation of the fistula was performed together with the operative ligation of a crossover feeding artery from the left vertebral artery. Her heart size, heart rate and blood pressure were successively normalized.

Endovascular Management of Pediatric High-Flow Vertebro-Vertebral Fistula with Reversed Basilar Artery Flow

“…VAVFs are relatively rare and have been reported in association with connective tissue diseases including fibromuscular dysplasia, neurofibromatosis, Ehler-Danlos syndrome, and Marfan's syndrome [3][4][5] . Although VAVFs are commonly encountered in adults secondary to post-traumatic and/or iatrogenic arteriov-enous complications, spontaneous and congenital VAVFs have rarely been described in the pediatric population 2,6,7 .…”

Lower vertebral-epidural spinal arteriovenous fistulas: a unique subtype of vertebrovertebral arteriovenous fistula, treatable with coil and Penumbra Occlusion Device embolization

“…The term VVAVF has been broadly used to characterize extradural AVFs in which the arteriovenous shunt occurs between the vertebral artery and any adjacent venous structure, including jugular,7 suboccipital,8 paraspinal,9 and epidural veins 3. When epidural venous drainage is present, more often than not, it occurs indirectly via retrograde drainage from the primary paraspinal venous drainage of the fistula.…”

“…Given the morbidity and technical demands of surgery, including the potential for significant blood loss and the need for wide operative exposure of the upper or lower cervical regions, and in light of continued improvements in endovascular technology, embolization has emerged as a primary approach for treatment of these fistulas. Detachable latex balloons23–25 (not available in the USA) and coils7 8 17 19 have the longest track record for this purpose, although more recently, liquid embolic agents26 27 have also been used for spinal AVF embolization. However, unlike coils, which can be retrieved before detachment if the pattern of deployment appears unfavorable, liquid embolic agents are not retrievable after injection, and pose the potential risk of distal embolization through the epidural plexus, or proximal embolization into the vertebral artery.…”

Combined transarterial and percutaneous coiling of a spontaneous vertebrovertebral fistula associated with neurofibromatosis Type 1

“…Surgery alone or in conjunction with an endovascular procedure may be useful for treating complex lesions. 10 Various endovascular techniques are available for the management of VVFs. Commonly described techniques include transarterial use of detachable balloons, 1,5 transarterial placement of detachable coils at the fistulous site with or without trapping of the parent vessel, 9,13 and placement of a covered stent in the feeding artery.…”