Vertebral arteriovenous fistula that developed in the same place as a previous ruptured aneurysm: a case report

Ushikoshi, Satoshi; Goto, Katsuya; Uda, Kouji; Ogata, Noboru; Takeno, Yoshiaki

doi:10.1016/s0090-3019(98)00011-1

Cited by 40 publications

(40 citation statements)

References 14 publications

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“…A fistula can develop due to arterial growth during the process of organization and recanalization. 5,6 Another mechanism of fistula formation is increased venous pressure due to impaired venous drainage after trauma causing spontaneous occurrence. 6 There is no question that trauma was the cause of fistula formation in our patient.…”

Section: Discussionmentioning

confidence: 99%

Spinal Intraosseous Arteriovenous Fistula in the Fractured Vertebral Body

Jin¹,

Chung²,

Kwon³

et al. 2009

AJNR Am J Neuroradiol

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SUMMARY:A 68-year-old woman presenting with progressive paraparesis was diagnosed with an AVF involving a previously fractured L1 vertebral body on which feeders from multiple segmental arteries converged. The most distinctive feature in our patient was that the fistula was located in the vertebral body. Transarterial embolization of the segmental arteries with coils and glue resulted in total obliteration of the fistula, which in turn resulted in symptom improvement.ABBREVIATION: AVF ϭ arteriovenous fistula E pidural or paraspinal AVF is very rare, and few cases have been reported in the literature.1-4 It is not a well-known entity, and it is not always easy to distinguish an epidural AVF from a dural AVF when reflux into the perimedullary veins is present. Although intradural reflux is rare in paravertebral shunts, it may show angiographic findings similar to those of a dural AVF and venous hypertension of the spinal cord.2 We report a case of trauma-related intraosseous fistula directly draining through the L1 basivertebral vein into the epidural, paraspinal, and perimedullary venous plexuses. Case ReportA 68-year-old woman presented with a 5-month history of a tingling sensation in both legs and a 2-month history of gradually progressive paraparesis. In addition, she also had a 9-year history of back pain after falling from a ladder.Neurologic examination revealed that she was unable to walk steadily and had paraparesis (grade IV/V). Sensory examination demonstrated paresthesia and hypesthesia of the perianal area and both lower extremities, symmetrically. Urinary retention and fecal incontinence were noted. Her deep tendon reflexes were slightly increased in the bilateral lower extremities. Pathologic reflexes, such as ankle clonus and Babinski sign, were positive.Engorged intraosseous and perimedullary veins accompanying cord signal-intensity changes were detected on CT scans (Fig 1A, -B) and MR images (Fig 2). Spinal angiography showed intraosseous fistulas and multiple feeders from bilateral L1 and L2 and right T12 segmental arteries (Fig 3).She was diagnosed with trauma-related epidural or paraspinal AVF. We confirmed that the venous flow drained mainly via the intraosseous L1 basivertebral vein into the epidural venous plexus on the left in a downward direction; then, the flow drained into the left paravertebral veins on the spinal angiography. We tried embolization through the left femoral vein but failed to find the connection between the epidural or paravertebral vein and the left femoral vein or inferior vena cava. Transarterial embolization was selected as the treatment technique.The muscular branches in each segmental artery were protected by coils due to the delay of wound healing, which might have been caused by occlusion of superficial arteries during embolization. Multiple feeders were occluded, including the venous sac, with 33% glue-that is, a mixture of n-butyl cyanoacrylate (Histoacryl; B. Braunn, Melsungen, Germany) and iodized oil (Lipiodol; Guerbet, Aulnay-Sous-Bois, France) at a ratio...

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Section: Discussionmentioning

confidence: 99%

Spinal Intraosseous Arteriovenous Fistula in the Fractured Vertebral Body

Jin¹,

Chung²,

Kwon³

et al. 2009

AJNR Am J Neuroradiol

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“…7) In fact, a previous case, treated with proximal occlusion with a detachable balloon, developed vertebral arteriovenous fistula in the same region 11 years later. 20) Therefore, endovascular trapping of the distal parent artery, aneurysm, and proximal parent artery is supposed to be a better treatment modality. Direct surgery was selected in earlier cases, whereas endovascular treatment was chosen in more recent cases.…”

Section: Discussionmentioning

confidence: 99%

“…The renal artery is most frequently involved, resulting in renovascular hypertension. 14,20) However, extracranial VA aneurysm is rarely associated with neurofibromatosis. 1,2,5,6,[8][9][10]12,13,[15][16][17][18][19][20] We report a case of ruptured extracranial VA aneurysm in a patient with NF1 treated successfully by endovascular embolization.…”

Section: Introductionmentioning

confidence: 99%

Ruptured Extracranial Vertebral Artery Aneurysm Associated With Neurofibromatosis Type 1

Hiramatsu

Matsui

Yamashita

et al. 2012

Neurol. Med. Chir.(Tokyo)

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A 31-year-old man presented with a ruptured right extracranial vertebral artery aneurysm associated with neurofibromatosis type 1, manifesting as acute onset of right neck and shoulder pain, and right supraclavicular mass. Three-dimensional computed tomography angiography showed a large aneurysm involving the right extracranial vertebral artery associated with a pseudoaneurysm. The aneurysm was successfully treated by transarterial endovascular trapping with detachable coils. Extracranial vertebral artery aneurysm is rare, but the mortality of ruptured cases is extremely high, so early diagnosis and early treatment are important. The present case shows that endovascular treatment was very effective.

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“…1,4,6,10,11) The stent-graft was first used to treat aortic aneurysm, 9) and has since rapidly evolved for the treatment of aneurysms and traumatic lesions like AVFs of large vessels such as the aorta, iliofemoral arteries, and subclavian arteries. 1,4,6,[10][11][12][13][14][15] In the head and neck region, use is limited to major branches of the aorta such as the subclavian artery, brachiocephalic artery, and cervical carotid arteries. 1,4,6,7,10) Only one vertebral AVF was treated with a stent-graft based on a Palmaz stent and autologous saphenous vein graft.…”

Section: Discussionmentioning

confidence: 99%

“…2,3,5,8,14) However, an AVF with a large orifice is sometimes difficult to treat without sacrificing the patency of the artery. Preservation of the patency of the artery is preferred in a young patient, or if the patient cannot tolerate vessel occlusion.…”

Section: Introductionmentioning

confidence: 99%

Large Vertebral Arteriovenous Fistula Treated With Stent-Grafts-Case Report-

Sadato

Satow

Ishii

et al. 2003

Neurol. Med. Chir.(Tokyo)

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A 24-year-old woman presented with neck bruit and thrill. Neurological examination revealed no focal abnormality. Angiography and magnetic resonance imaging showed an arteriovenous fistula (AVF) at the C4-5 levels of the right vertebral artery (VA). The fistula had a single orifice that drained into the epidural veins via the C4-5 intervertebral foramen. A stent-graft was made of a 3.9 cm balloon-expandable stent and an expandable polytetrafluoroethylene graft sutured outside the stent. The stent-graft was advanced through the femoral artery up to the VA but did not pass far enough distally to seal the entire fistula because of the high friction between the bulky device and the small vessel. Another 2 cm stentgraft was delivered and successfully positioned across the fistula. The AVF completely disappeared and the right VA was well preserved. Follow-up angiography at 3 weeks and 5 months after the treatment showed no fistula and no stenosis inside the stent-grafts. Stent-grafts are useful to treat AVF with a large orifice. The stent-graft is a promising technology to treat neurovascular diseases, although improvement is required for use in smaller vessels.

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Vertebral arteriovenous fistula that developed in the same place as a previous ruptured aneurysm: a case report

Cited by 40 publications

References 14 publications

Spinal Intraosseous Arteriovenous Fistula in the Fractured Vertebral Body

Spinal Intraosseous Arteriovenous Fistula in the Fractured Vertebral Body

Ruptured Extracranial Vertebral Artery Aneurysm Associated With Neurofibromatosis Type 1

Large Vertebral Arteriovenous Fistula Treated With Stent-Grafts-Case Report-

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