Traumatic Vertebro-vertebral Arteriovenous Fistula Manifesting as Radiculopathy -Case Report-

Abstract

A 58-year-old man presented with a traumatic vertebro-vertebral arteriovenous fistula (VVAVF) after attempting suicide by thrusting scissors into his right anterior cervical region. Two months later he noticed weakness and numbness of the right upper extremity. Examination revealed bruit in the right neck, no cranial nerve palsy, and weakness of the right deltoid and biceps muscles. Hypalgesia and hypesthesia were noted in the right C5 and C6 dermatomes. Magnetic resonance imaging demonstrated a mass lesion on the right ventral aspect of the spinal canal from C2 to C7. Right vertebral artery angiography showed a pseudoaneurysm of the right vertebral artery and a high-flow arteriovenous fistula between the right vertebral artery and vein. The right vertebral artery was occluded with detachable coils because the fistula showed high blood flow and the right posterior inferior cerebellar artery was well opacified from the left vertebral artery. This procedure resulted in complete obliteration of the arteriovenous fistula. The preoperative motor and sensory symptoms improved. Endovascular treatment by coil embolization was effective in our patient with traumatic VVAVF.

Endovascular correction of a traumatic internal iliac arteriovenous fistula with a covered stent

“…He used balloons positioned in catheters to make the first attempts to deobstruct atherosclerotic stenosis and peripheral arteries 9 . From the same decade onwards, endovascular diagnosis together with interventional radiology procedures, had made it possible to treat hemorrhages in organs and parts of the body using therapeutic embolization or arterial stenosis using angioplasty 10 .…”

“…Over the last decade these procedures have undergone an extraordinary rate of development into the arterial tree, in the most diverse range of different vessels, and are now no longer a secondary or exceptional option, but the principal treatment 10 . The first reports of the use of these techniques to close AVFs, especially traumatic AVFs, only appeared recently 9 . Treatment includes embolization of fistulae with a variety of agents, such as autologous blood clots; Gelfoam sponges; microfibrillar collagen (Avitene ® ); polyvinyl alcohol sponges (Ivalon ® ); coils -copolymer covered; detachable and nondetachable balloons, and cyanoacrylate (Brucrylate…”

Paraspinal arteriovenous fistula: Stuttgart classification based on experience and a review of the literature

“…Symptoms vary depending on the location and volume of the shunt and comprise an audible bruit, motor weakness, sensory disturbance, radiculopathy, pulsatile tinnitus or headache ( Figure 2). [15][16][17]19 Besides vertebrovertebral or vertebrojugular PAVSs, only a few traumatic paraspinal shunts are reported in the literature. Cognard et al published the case of a 17-year-old girl, presenting with a history of progressive lower back pain, which begun 6 months after she had fallen from a horse.…”

Cervical spinal extradural arteriovenous fistula successfully treated using transarterial balloon-assisted coil embolization

“…SEDAVF can cause compressive radiculopathy or myelopathy due to mechanical compression of root sleeve or thecal sac by dilated extradural venous plexus, 14 ) 22 ) 27 ) and congestive myelopathy due to increased medullary venous pressure by intradural retrograde blood reflux. 13 ) 17 ) In addition, in the case of high-flow arteriovenous shunting in which arterial feeder occurs directly in vertebral artery (VA), there can be not only sensations of bruit or tinnitus, 7 ) 19 ) 20 ) 28 ) but also cerebellar symptoms such as vertigo and ataxia caused by vascular steal effect.…”