Question:

Which of the following statements are correct regarding vertebral arteriovenous fistulae?
1. Surgical management is straight-forward
2. Endovascular management is contra-indicated
3. Coil deployment in the vertebral vein can theoretically lead to nerve root compression
4. Stent-grafting of the vertebral artery is subject to subsequent occlusion
5. Doppler ultrasound is useful for follow-up post intervention





Answer:

The correct answers for the question "Which of the following statements are correct regarding vertebral arteriovenous fistulae?" are:

3. Coil deployment in the vertebral vein can theoretically lead to nerve root compression

4. Stent-grafting of the vertebral artery is subject to subsequent occlusion

5. Doppler ultrasound is useful for follow-up post intervention



Explanation

a) Surgical management of vertebral AV fistulae is technically difficult owing to the vessel`s anatomical position that makes adequate exposure and vessel control challenging.

b) Endovascular strategies include embolisation through coil deployment, detachable balloon occlusion and covered stent grafting of the artery.

c) In the case of a dilated vertebral vein, a large amount of embolic material may be needed to be deposited within this vessel close to the intervertebral foramen potentially tightening the foramen and compressing the nerve root.

d) In the presence of a patent artery, endovascular reconstruction of the artery using covered stents is advocated. This conveys the theoretical advantage of maintaining flow within the vessel. However, the vertebral artery is subject to compression form external structures and early cases of stent occlusion have been described.

e) Doppler ultrasound is a cheap and minimally invasive test that is often used as a first line investigation, especially in the context of a bruit or murmur and is often useful as a follow-up tool.



From the manuscript:
Delayed presentation of a vertebral arterio-venous fistula secondary to penetrating cervical trauma: endovascular management using coil embolisation - a case report
Radiology Case. 2009 Jun; 3(6):9-15


This article belongs to the Interventional section.




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From the manuscript

Delayed presentation of a vertebral arterio-venous fistula secondary to penetrating cervical trauma: endovascular management using coil embolisation - a case report

Free full text article: Delayed presentation of a vertebral arterio-venous fistula secondary to penetrating cervical trauma: endovascular management using coil embolisation - a case report

Abstract
Vertebro-vertebral arteriovenous fistulae occur infrequently. We report on such a case with delayed presentation following penetrating neck injury. This was successfully treated via coil embolisation. A 40-year-old woman presented with a subjective tinnitus that was abolished by turning her head to the right. She had sustained penetrating neck trauma 6 months earlier. Doppler Ultrasound and magnetic resonance angiogram confirmed the presence of a vertebral arterio-venous fistula. Using a trans-femoral arterial approach, the left vertebral artery was embolised by deployment of multiple coils. The patient had no return of symptoms at 3 months follow up. Radiological diagnosis and endovascular management of this condition is discussed.






References



1. Amirijamshidi A, Abbassioun K, Rahmat H. Traumatic aneurysms and arteriovenous fistulas of the extracranial vessels in war injuries. Surg Neurol 2000; 53:136-145.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


2. Gobin YP, Duckwiller GR and Vinuela F. Direct arteriovenous fistulas (carotid-cavernous and vertebral-venous). Neuroimaging Clin N Am 1998; 8: 425-443.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


3. Tenjin H, Kimura S and Sugawa N. Coil embolization of vertebro-vertebral arteriovenous fistula: a case report. Surg Neurol 2005; 63: 80-83
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


4. Albuquerque F, Javedan S, McDougall C. Endovascular management of penetrating vertebral artery injuries. J Trauma 2002; 53: 574-580.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


5. Halbach VV, Higashida RT, Heishima GB. Treatment of vertebral arteriovenous fistulas. Am J Roentgnol 1988; 150: 405-12.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


6. Gonzalez A, Mayol A. Endovascular stent-graft treatment of an iatrogenic vertebral arteriovenous fistula. Neuroradiol 2001; 43:784-786.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


7. Singer RJ, Dake MD. Covered stent placement for neurovascular disease. Am J Neuroradiol 1997; 18: 507-509.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


8. Huttl K, Sebestyen M. Covered stent placement in a traumatically injured vertebral artery. J Vasc Intervent Radiol 2004; 15: 201-2.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


9. Sadato A, Satow T. Large vertebral arteriovenous fistula treated with stent-grafts--case report. Neurologia Medico-Chirurgica 2003; 43:250-254.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


10. Bahar S, Chiras J. Spontaneous vertebro-vertebral arterio-venous fistula associated with fibro-muscular dysplasia. Report of two cases Neuroradiol 1984; 26:45-49
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


11. Deans WR, Bloch S, Leibrock L. Arteriovenous fistula in patients with neurofibromatosis. Radiol 1982; 144:103-107.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


12. Tay KY, U-King-Im JM. Imaging the vertebral artery. Euro Rad 2005; 15: 1329-1343.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


13. Sharma AK, Westesson P. Preoperative evaluation of spinal vascular malformation by MR angiography: How reliable is the technique: Case report and review of literature. Clin Neurol and Neurosurg 2008; 210: 521-524.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


14. Stuhlfaut JW, Glenn Barest G. Impact of MDCT Angiography on the use of Catheter Angiography for the assessment of cervical arterial injury after blunt or penetrating trauma. Am J Roentgenol 2005; 185:1063-1068
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


15. Núñez DB, Torres-León M, Múnera F. Vascular injuries of the neck and thoracic inlet: Helical CT-Angiographic correlation. Radiographics 2004; 24:1087-1098.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine




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