Stent-Grafting for Vertebrojugular Arteriovenous Fistula: An Elegant Solution but the Best Course of Action?

Recurrent Vertebral Arteriovenous Fistula after Surgical Repair: Treatment with a Self-Expanding Stent-Graft

“…There is also a reduced risk of external compression, which could be potentially fatal in the presence of an asymmetrical vertebral supply such as our patient had. The hypoplastic left vertebral artery was considered insufficient for posterior cerebral circulation, so endovascular coil occlusion above and below the fistula, a well established therapy, 13 was not suitable.…”

Iatrogenic Vertebral Arteriovenous Fistula Treated with a Hemobahn Stent-Graft

“…This endograft, which consists of PTFE sandwiched between 2 stainless steel stents, would be susceptible to deformation and possible occlusion from external forces. Rowlands 13 criticized this mode of treatment, stating the stent-graft was an unproven device in this setting compared to coil or balloon embolization, which he thought would have been safer in a small (3-mm), non-dominant vertebral artery.…”

“…It is true that the flow above the fistula was reversed, so occluding it would be unlikely to cause any vertebrobasilar symptoms, but embolization would have been very difficult in a large diameter vessel and a high-flow fistula. Rowlands 13 also stated that maintaining stent-graft patency would require lifelong antiplatelet therapy to counter the increased risk of restenosis, occlusion, or embolization. While this may be true in a 3-mm, non-dominant vertebral artery, it is unlikely that these events would be a concern in larger arteries, such as in our patient.…”