Endovascular Treatment of an Iatrogenic Vertebrojugular Fistula With a Balloon-Expandable Covered Stent: Case Report and Review of the Literature

Abstract

We report a case of a fistula between the vertebral artery and the internal jugular vein that occurred after the erroneous placement of a central venous catheter. The patient was presented with tinnitus. Endovascular treatment with a balloon expandable covered stent placed into the vertebral artery was performed. One year follow-up showed satisfactory exclusion of the fistula, patency of the stented vertebral artery, and resolution of the symptoms. Only few other similar cases are reported in the literature with the use of different types of stents.

Vertebral Arteriovenous Fistula: An Unwelcome Thrill

“…Infrequently, vertebral AVFs arise through atraumatic processes, either congenitally or spontaneously. Approximately one-third of those that are spontaneous occur in patients with underlying genetic disorders, like neurofibromatosis type 1, or connective tissue disorders, such as Ehler-Danlos syndrome [4]. Vertebral AVFs most frequently present as pulsatile bruits and tinnitus, a result of turbulent blood flow within the aberrant arteriovenous connection [4, 5].…”

“…Approximately one-third of those that are spontaneous occur in patients with underlying genetic disorders, like neurofibromatosis type 1, or connective tissue disorders, such as Ehler-Danlos syndrome [4]. Vertebral AVFs most frequently present as pulsatile bruits and tinnitus, a result of turbulent blood flow within the aberrant arteriovenous connection [4, 5]. Less common manifestations include vertigo, neurological deficits, and neck pain, though up to 30% of vertebral AVFs may be asymptomatic at diagnosis [6, 7].…”

“…If left untreated, these fistulae can produce symptoms of vertebrobasilar insufficiency via vascular steal phenomena, aneurysm formation with subsequent thromboembolism due to abnormal flow patterns, compressive myeloradiculopathy due to progressive engorgement of the cervical epidural veins, or catastrophic intramedullary hemorrhage due to intramedullary venous hypertension [4]. Historically, ligation was the only available intervention, though compared to current techniques it is considered more invasive and challenging to perform given the artery course through the cervical vertebrae [4]. Endovascular methods, including the use of detachable balloons, liquid agents, coils, and stent grafts, have greatly enhanced the success and safety of treating AVFs.…”