An Unusual Case of Vertebral Arteriovenous Fistula Treated with Electrodetachable Coil Embolization

Abstract

Vertebral arteriovenous fistulas (VAF) are rare clinical entities. Most are post-traumatic in origin, following direct injury, or iatrogenic. Treatment options include endovascular occlusion or direct surgical closure. We present a rare case of a spontaneous VAF, presenting with cervical and upper limb pain in a patient with previous chiropractic manipulations, successfully treated with electrodetachable coil embolization. While the natural history of the VAFs is still to be settled, endovascular occlusion appears to be a safe and reliable method to deal with such lesions, mainly in symptomatic cases. The use of electrically detachable coils may be considered as an effective alternative for the endovascular occlusion of these fistulas.

Key words

Arteriovenous fistula - endovascular embolization - electrodetachable coils - vertebral artery

References

• 1 Halbach V van, Higashida R T, Hieshima G B. Treatment of vertebral arteriovenous fistulas.  AJR. 1988;  150 405-412
• 2 Reddy M, Schoggl A, Saringer W, Reddy B, Matula C. Traumatic arteriovenous fistula of the vertebral artery.  Neurol Med Chir (Tokyo). 2002;  42 289-292
• 3 Deans W R, Block S, Leibrock L, Berman B M, Skultety F M. Arteriovenous fistula in patients with neurofibromatosis.  Radiology. 1982;  144 103-107
• 4 Beaujeux R L, Reizine D C, Casasco A, Aymard A, Rüfenacht D, Khayata M H, Riche M-C, Merland J-J. Endovascular treatment of vertebral arteriovenous fistula.  Radiology. 1992;  183 361-367
• 5 Kai Y, Hamada J-I, Mizuno T, Kochi M, Ushio Y, Kitano I. Transvenous embolization for vertebral arteriovenous fistula: report of two cases and technical notes.  Acta Neurochir. 2001;  143 125-128
• 6 Taylor C G, Husami Y, Colquhoun I R, Byrne J V. Direct cervical vertebra-venous fistula with radiculopathy and MRI changes resolving after successful endovascular embolization: a report of two cases.  Neuroradiology. 2001;  43 1118-1122
• 7 Jansen O, Darfier A, Forsting M, Hartmann M, Kummer R von, Tronnier V, Sartor K. Endovascular therapy of arteriovenous fistulae with electrolytically detachable coils.  Neuroradiology. 1999;  41 951-957
• 8 Spetzler R F, Detwiler P W, Riina H A, Porter R W. Modified classification of spinal cord vascular lesions.  J Neurosurg (Spine 2). 2002;  96 145-156
• 9 Gonzalez A, Mayol A, Gil-Peralta A, Gonzalez-Marcos J R. Endovascular stent-graft treatment of an iatrogenic vertebral arteriovenous fistula.  Neuroradiology. 2001;  43 784-786
• 10 Miralbes S, Catlin F, Andrea I, Bonneville J F. Vertebral arteriovenous fistula: endovascular treatment with electrodetachable coils.  Neuradiology. 1998;  40 761-762
• 11 Weinberg P E, Flom R A. Traumatic vertebral arteriovenous fistula.  Surg Neurol. 1973;  1 162-167
• 12 Cosgrove G R, Theron J. Vertebral arteriovenous fistula following anterior cervical spine surgery. Report of two cases.  J Neurosurg. 1987;  66 297-299
• 13 Merland J J, Reizine D, Riche M C, George B, Guimaraens L, Lauren A, Melki J P. Endovascular treatment of vertebral arteriovenous fistulas in twenty-two patients.  Ann Vase Surg. 1986;  1 73-78
• 14 Higashida R T, Halbach V van, Tsai F Y, Norman D, Pribram H F, Mehringer C B, Hieshima G B. Interventional neurovascular treatment of traumatic carotid and vertebral artery lesions: results in 234 cases.  AJR. 1989;  153 577-582
• 15 Halbach V V, Higashida R T, Hieshima G B, Norman D. Normal perfusion pressure breakthrough occurring during treatment of carotid and vertebral fistulas.  AJNR. 1987;  5 761-765
• 16 Guglielmi G, Vinuela F, Duckwiler G, Dion J, Stocker A. High-flow, small-hole arteriovenous fistulas: treatment with electrodetachable coils.  AJNR. 1995;  16 325-328
• 17 Yoshida S, Nakazawa K, Oda Y. Spontaneous vertebral arteriovenous fistula: case report.  Neurol Med Chir. 2000;  40 211-215
• 18 Accreditation council on graduate medical education . Embolization of spinal arteriovenous fistulae, spinal arteriovenous malformations, and tumors of the spinal axis.  AJNR. 2001;  (Suppl) 22 S28-S30