Iatrogenic vertebral arteriovenous fistulae

Acute Formation of a Blunt Trauma-induced Vertebral Artery Arteriovenous Fistula Treated with Endovascular Occlusion of Vertebral Artery

“…However, there were significant morbidity and high failure rates via open surgery [11-12]. This was likely due to ineffective proximal vertebral artery ligation because of the extensive anastomotic circulation between the external carotid and vertebral arterial systems [13-14]. Due to advancements in endovascular technology and technique, spinal AVFs can be treated with low morbidity and high treatment success via obliteration of the fistula and preservation of flow in the parent vertebral artery [15-16].…”

Vertebral arteriovenous fistulae. Report of two cases and review of the literature

“…A complaint of a noise poorly localized in the head and a neck mass may be all that bothers the patient 44' 45; symptoms related to cardiac failure, neurological symptoms pointing to posterior circulation insufficiency, radiculopathy due to nerve root compression, respiratory symptoms due to tracheal compression by the fistula itself or by the sometimes associated hematoma or upper airways bleeding have only been infrequently described 11,34,44,48,51 A few cases, including our case # 1, seem to suggest the possibility of the spinal cord being involved in relation to the fistula as demonstrated by clinical improvement after its elimination 32, 37. The fistula may directly compress the cord through the dilated intraspinal venous plexus; moreover cord function may be impaired on a vascular basis by increased pressure in the medullary veins and by decreased flow in the medullary arteries, both a direct consequence of the local haemodynamic changes caused by the arteriovenous shunt 28,32 A systolic neck bruit variably radiating cranially and caudally is usually present 45. The unreliability of localizing the bruit to the cartoid circulation by observing its disappearance after carotid compression in the neck, first pointed out by Matas in 1893 ~9, has since then often been confirmed 8,36,45.…”

Surgical Neuroangiography

“…Due to the close proximity between the vertebral artery and the paravertebral venous plexus, arteriovenous fistulas following trauma and direct puncture vertebral angiography are relatively more frequent than pseudo aneurysms (see Chapter 6, VAFs) (Davis 1983, Dutton 1970, Jamieson 1965, Lester 1966, McDowell 1971. Due to the close proximity between the vertebral artery and the paravertebral venous plexus, arteriovenous fistulas following trauma and direct puncture vertebral angiography are relatively more frequent than pseudo aneurysms (see Chapter 6, VAFs) (Davis 1983, Dutton 1970, Jamieson 1965, Lester 1966, McDowell 1971.…”