Contralateral HeRO Graft Insertion to Treat Severe Venous Hypertension and Preserve Arteriovenous Fistula Patency

Intracerebral hemorrhage is a devastating form of stroke and is more common in patients with hypertension and renal disease. We present the case of a lady suffering from chronic kidney disease who presented with severe headache and aphasia. On evaluation, she was found to have an intraparenchymal hemorrhage in the left temporal lobe with prominent pial and dural veins suggestive of a dural arteriovenous fistula (DAVF). Subsequently, she was detected to have occlusion of the left brachiocephalic vein (LBCV), which resulted in venous hypertension and resulted in this rare complication. Angioplasty followed by stenting of the LBCV resulted in subsidence of her symptoms. We wish to highlight this unusual but treatable complication of limb AV fistula which can mimic intracranial DAVF.

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Development of a dural arteriovenous fistula subsequent to cerebral venous thrombosis by venous hypertension

eNeurologicalSci ◽

10.1016/j.ensci.2018.11.015 ◽

2019 ◽

Vol 14 ◽

pp. 24-27

Author(s):

Min Kyoung Kang ◽

Young-Dae Cho ◽

Hyun-Seung Kang ◽

Keun-Hwa Jung

Keyword(s):

Venous Thrombosis ◽

Arteriovenous Fistula ◽

Cerebral Venous Thrombosis ◽

Dural Arteriovenous Fistula ◽

Venous Hypertension

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Intracranial pial single-channel arteriovenous fistula presenting with significant brain edema

Journal of Neurosurgery ◽

10.3171/jns/2008/109/9/0497 ◽

2008 ◽

Vol 109 (3) ◽

pp. 497-501 ◽

Cited By ~ 11

Author(s):

Jun Masuoka ◽

Shuji Sakata ◽

Kenji Maeda ◽

Toshio Matsushima

Keyword(s):

Arteriovenous Fistula ◽

Brain Edema ◽

Single Channel ◽

Vasogenic Edema ◽

Obstructive Hydrocephalus ◽

Venous Drainage ◽

Venous Hypertension ◽

Anterior Inferior Cerebellar Artery ◽

Arteriovenous Shunts ◽

Consciousness Disturbance

The authors report a rare case of pial single-channel arteriovenous fistula presenting with significant brain edema. A 51-year-old woman was admitted with a 5-day history of headache and nausea, followed by consciousness disturbance. Computed tomography showed cerebellar swelling with obstructive hydrocephalus. Magnetic resonance imaging revealed extensive vasogenic edema in the cerebellum bilaterally. Angiography demonstrated 2 different arteriovenous shunts (AVSs) at peripheral branches of the right anterior inferior cerebellar artery. One was located on the suboccipital surface. It drained through a dilated inferior vermian vein and emptied retrogradely into the contralateral cerebellar veins with marked stagnation. Focal stenosis of the dilated draining vein was present. The other AVS was located on the petrosal surface, which had a slow flow with no angiographic evidence of venous congestion. Given that the latter was believed to be asymptomatic, the former AVS was excised, and histological examination revealed that the lesion consisted of a direct communication of multiple arterial feeding vessels with a single vein, consistent with a diagnosis of pial single-channel arteriovenous fistula. The restriction of venous drainage presumably caused venous hypertension, leading to the brain edema and neurological symptoms.

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A rare case of arteriovenous fistula formation in a patient with inferior vena cava thrombosis, successfully managed with endovascular recanalisation

BJR|case reports ◽

10.1259/bjrcr.20190007 ◽

2019 ◽

Vol 5 (4) ◽

pp. 20190007

Author(s):

Vanya Joshi ◽

Frances Sheehan ◽

Alexander Chapman

Keyword(s):

Inferior Vena Cava ◽

Arteriovenous Fistula ◽

Animal Studies ◽

Inferior Vena ◽

Vena Cava ◽

Lower Extremities ◽

Venous Hypertension ◽

Fistula Formation ◽

Ivc Thrombosis ◽

Ivc Filters

Inferior vena cava (IVC) filters are recommended for patients with proximal deep vein thrombosis (DVT) who are not eligible for anticoagulation. Long-dwelling filters are well-known to be associated with the development of IVC thrombosis. Chronic caval occlusion can lead to a severe post-thrombotic syndrome (PTS), with manifestations of chronic venous insufficiency in the lower extremities. Animal studies have shown that post-thrombotic inflammation can trigger the development of an arteriovenous fistula (AVF), however, there is limited evidence for this phenomenon in patients with PTS. We describe the case of a spontaneous AVF in a patient with long-standing IVC thrombosis. It was postulated that the AVF could be compounding the venous hypertension and severe swelling of his lower extremities. The case additionally demonstrates the successful results of endovascular recanalisation for an occluded filter in the presence of an AVF.

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