Endovascular Management of Traumatic Vertebral Artery Pseudoaneurysm Associated with Vertebral Arteriovenous Fistula Using a Covered Stent

Abstract

Vertebral arteriovenous fistula is an abnormal communication between the vertebral artery and adjacent venous structures. The most common cause of vertebral arteriovenous fistula is trauma, however, spontaneous occurrence is also known. We report a case of traumatic pseudoaneurysm with associated vertebral arteriovenous fistula which occurred following stab injury to the left vertebral artery. The diagnosis was suspected clinically and on CT angiography. Digital subtraction angiography confirmed the diagnosis, and a covered stent was placed in the left vertebral artery at the site of the injury following which there was complete closure of the pseudoaneurysm and fistula and anterograde flow was restored in the vertebral artery.

Case report: Traumatic carotid and vertebral arteries Pseudoaneurysm associated with vertebral arteriovenous fistula

“…Mahmoud [2] reported a child who was injured by a knife had PSA of the common carotid artery and vertebral artery, and they nally abandoned the common carotid artery. Gupta [4] reported a case of PSA and AVF related vertebral artery caused by penetrating neck injury, and the patient nally received intravascular stent implantation. Although our patient presented with severe vascular injury in the neck and massive cerebral infarction in the left side, MRA and DSA showed no abnormalities in intracranial vessels.In order to restore the function of the left hemispheres much as possible, we chose to preserve the common carotid artery.…”

“…There is direct connection among vertebral artery, muscle or nerve root branches and peripheral vein structures [3]. The most common cause of vertebral AVFs is blunt or penetrating trauma to the neck, which may have no obvious clinical manifestations [3,4].…”

Endovascular Reconstruction of a Vertebral Artery After Traumatic Arteriovenous Fistula Using Flow Diversion: 2-Dimensional Operative Video

“…1 These complex injuries can commonly be treated by vessel sacrifice dependent on collateral flow from the contralateral vertebral artery by both open and endovascular approaches. 2-5 Others have treated these cases with covered stents 6 and flow diversion. 7,8 Advances in flow diversion technology have led to their use in other pathologies, including carotid cavernous fistulas 9 and vertebral artery pseudoaneurysms.…”