scholarly journals An Unusual Suspect for a Traumatic Arteriovenous Fistula in the Left Vertebral Artery

2020 ◽  
Vol 44 (1) ◽  
pp. 28-31
Author(s):  
Cassey Y. Noh
Keyword(s):  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
Genetic Disorders ◽  
Invasive Procedure ◽  
Left Vertebral Artery ◽  
Medical Procedure ◽  
Doppler Waveform ◽  
Spectral Doppler ◽  
Vascular Laboratory ◽  
History Of

This case study discusses an unusual vertebral arteriovenous fistula of a patient with no history of an invasive medical procedure or underlying genetic disorders. The patient is a 54-year-old female with a history of tinnitus for 6 months behind the left ear prior to coming to the vascular laboratory. There was a connection between the left vertebral artery and the vertebral vein, which showed a mosaic pattern with a high velocity. The spectral Doppler waveform in the vertebral vein post the unintended anastomosis showed an arterialized venous Doppler waveform, confirming that the area of the interest was indeed an arteriovenous fistula. The image of the screening computed tomography performed on the same day did not show this connection or dilated venous system, possibly because of the small size of the fistula. A published literature suggests hyperextension as a possible suspect. There are a few test modalities that can identify an arteriovenous fistula, but ultrasound maybe the most desirable due to the fact that it does not involve an invasive procedure or a contrast dye. It is very important for a sonographer to learn the advanced information such as how to identify a true arteriovenous fistula with the analysis of Doppler waveform in the vein post the anastomosis. In doing so, it will increase the sonographer’s knowledge as well as promoting the field of ultrasound overall.

Acute Traumatic Vertebral Arteriovenous Fistula: Balloon Occlusion with the Use of a Contralateral Approach

Neurosurgery ◽  
1984 ◽  
Vol 14 (2) ◽  
pp. 225-229 ◽  
Author(s):  
Richard E. Miller ◽  
Grant B. Hieshima ◽  
Steven L. Giannotta ◽  
Verity S. Grinnell ◽  
Mark C. Mehringer ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
False Aneurysm ◽  
Distal Segment ◽  
Balloon Occlusion ◽  
Left Vertebral Artery ◽  
Contralateral Approach ◽  
Endovascular Occlusion ◽  
Vertebral Arteriovenous Fistula

Abstract A traumatic fistula of the left vertebral artery to vertebral and epidural veins with an expanding suboccipital false aneurysm was trapped by endovascular occlusion with detachable balloons. The lesion was not amenable to treatment using the left vertebral artery alone for access. Distal trapping was accomplished by catheterizing the (contralateral) right vertebral artery and placing the balloon retrograde into the distal segment of the left vertebral artery. This maneuver extends the range of vertebral artery lesions for which detachable balloons, either alone or as an adjunct to operation, can be used.

scholarly journals Successful Treatment of Hemifacial Spasm Caused by an Ectatic Vertebral Artery Accompanying Agenesis of the Carotid Artery

2016 ◽  
Vol 02 (03) ◽  
pp. e105-e107 ◽  
Author(s):  
Ririko Takeda ◽  
Mai Ookawara ◽  
Goji Fushihara ◽  
Masahito Kobayashi ◽  
Takamitsu Fujimaki
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Successful Treatment ◽  
Hemifacial Spasm ◽  
Mild Hypertension ◽  
Left Vertebral Artery ◽  
Suboccipital Craniotomy ◽  
Root Exit Zone ◽  
History Of ◽  
Congenital Agenesis

We report the successful treatment of a patient with hemifacial spasm due to a tortuous vertebral artery that appeared to have developed to compensate for agenesis of the ipsilateral carotid artery. The 51-year-old man presented with a 1-year history of progressive left hemifacial spasm. His medical history was otherwise unremarkable except for untreated mild hypertension. Magnetic resonance angiography and bone window computed tomography demonstrated congenital agenesis of the left carotid artery and compression of the root exit zone of the left facial nerve by a tortuous left vertebral artery (VA). Microvascular decompression was performed via a left suboccipital craniotomy, and the offending vessel was identified using endoscopy. The vertebral artery was successfully transposed using polytetrafluoroethylene (PTFE) tape and a PTFE ball (Bard PTFE felt, Tempe, Arizona). This is the first report of a patient with hemifacial spasm caused by an ectatic VA associated with agenesis of the ipsilateral carotid artery.

scholarly journals Retrograde leptomeningeal venous approach for dural arteriovenous fistulas at foramen magnum

2015 ◽  
Vol 21 (2) ◽  
pp. 244-248 ◽  
Author(s):  
George AC Mendes ◽  
François Caire ◽  
Suzana Saleme ◽  
Sanita Ponomarjova ◽  
Charbel Mounayer
Keyword(s):  
Informed Consent ◽  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
Foramen Magnum ◽  
Left Vertebral Artery ◽  
Venous Reflux ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Vertebrobasilar Circulation ◽  
Work Up

A 72-year-old man presented with sudden right homonymous hemianopsia. Work-up imaging revealed a left occipital haematoma and an arteriovenous fistula supplied by the meningeal branches to the clivus from the left vertebral artery (VA) with a rostral venous reflux into cortical veins. A microcatheter was advanced through brainstem veins into the venous collector. A compliant balloon was placed in the left VA facing the origin of feeders. The balloon was inflated to protect the vertebrobasilar circulation from embolic migration. Onyx was injected by the transvenous catheter. Control angiogram revealed exclusion of the lesion. Informed consent was obtained from the patient.

A Case of Vertebrovertebral Arteriovenous Fistula Presenting with Subarachnoid Haemorrhage

1996 ◽  
Vol 2 (3) ◽  
pp. 229-233 ◽  
Author(s):  
S. Kominami ◽  
Y. Liu ◽  
H. Alvarez ◽  
G. Rodesch ◽  
P. Coubes ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Arteriovenous Fistula ◽  
Venous Drainage ◽  
Left Vertebral Artery ◽  
Detachable Balloon ◽  
Paediatric Case ◽  
History Of ◽  
Balloon Technique ◽  
Magnetic Resonance Imaging Mri ◽  
Tortuous Vessel

A rare paediatric case of vertebrovertebral arteriovenous fistula presented with a subarachnoid haemorrhage. A 12 year-old boy, who fell on his back at school, presented with a one week history of headache, vomiting, and double vision. Computed tomography (CT) scan revealed subarachnoid haemorrhage. Magnetic resonance imaging (MRI) demonstrated a tortuous vessel on the anterior surface of the spinal cord. Selective angiography showed an arteriovenous fistula of the left vertebral artery at the level of C1. The venous drainage of the fistula refluxed into the medullary vein at the level of C6-7, and drained upwards into the posterior fossa veins. An endovascular detachable balloon technique was employed and complete occlusion of the fistula was achieved.

Subclavian steal syndrome in a hemodialysis patient after percutaneous transluminal angioplasty of arteriovenous access

2018 ◽  
Vol 19 (4) ◽  
pp. 404-408 ◽  
Author(s):  
Yoko Kaneko ◽  
Takamoto Yanagawa ◽  
Yoshinori Taru ◽  
Sonoko Hayashi ◽  
Hong Zhang ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
High Flow ◽  
Subclavian Steal Syndrome ◽  
Left Vertebral Artery ◽  
Subclavian Steal ◽  
Percutaneous Transluminal ◽  
Steal Syndrome

Introduction: We describe a hemodialysis patient who developed subclavian steal syndrome via an arteriovenous fistula after percutaneous transluminal angioplasty. Case description: A 55-year-old female with end-stage renal failure due to polycystic kidney disease had been treated with hemodialysis for 10 years. Because of an autologous arteriovenous fistula stenosis, percutaneous transluminal angioplasty was performed. After successful treatment with percutaneous transluminal angioplasty, the patient developed dizziness. Magnetic resonance imaging with angiography of the brain and neck revealed normal bilateral subclavian and carotid arteries. However, flow in the left vertebral artery was not detected in time-of-flight magnetic resonance angiography. The left vertebral artery showed completely reversed blood flow as detected by color duplex ultrasound. We also confirmed anterograde flow in the left vertebral artery by color duplex ultrasound with arteriovenous fistula compression. Arteriovenous flows before the arteriovenous fistula stenosis and post-percutaneous transluminal angioplasty were 1146 and 2239 mL/min, respectively. These findings suggested high-flow arteriovenous fistula led to the subclavian steal syndrome. The patient was subsequently treated by a flow reduction in the high-flow arteriovenous access using a modified graft inclusion technique. We decreased the arteriovenous fistula flow to 851 mL/min, which remained under 850 mL/min, 1 year later. The brain natriuretic peptide level and right-ventricular pressure also decreased after treatment. A modified graft inclusion technique was successful in decreasing the high flow of the arteriovenous fistula, and improved subclavian steal syndrome symptom and cardiac overload. Conclusion: This case shows that percutaneous transluminal angioplasty for an arteriovenous fistula may induce subclavian steal syndrome, and a modified graft inclusion technique was useful in improving the high flow of an arteriovenous fistula.

scholarly journals Atraumatic Vertebral Artery Dissection in a Patient With a Migraine Headache

2021 ◽  
Author(s):  
Michael L Lloyd ◽  
Samuel Billingslea ◽  
Richard Slama
Keyword(s):  
Emergency Department ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Left Vertebral Artery ◽  
Artery Dissection ◽  
Intravenous Contrast ◽  
Lingual Gyrus ◽  
History Of ◽  
High Index Of Suspicion ◽  
Persistent Headache

ABSTRACT This case discusses a 34-year-old active duty male who presented to the emergency department with a 2-week persistent headache. His initial review of symptoms was reassuring until a detailed neurologic examination on his second visit revealed a visual deficit in the left upper quadrant. Additionally, he complained of intermittent tension headaches for the last several years but had no history of diagnosed migraines until he was seen 4 days prior for empiric migraine therapy in the same emergency department and left without improvement in symptoms. On his return visit, computerized tomography scan with intravenous contrast revealed a left vertebral artery dissection and hematoma. The patient was admitted for medical management and subsequently found to have suffered a small infarction of right lingual gyrus cortex on magnetic resonance imaging. This case illustrates the importance of maintaining a broad differential diagnosis and high index of suspicion in the patient with new focal neurologic findings in order to diagnose a potentially fatal disease.

Combined endovascular and surgical treatment in vertebral arteriovenous fistula

1997 ◽  
Vol 38 (1) ◽  
pp. 25-29 ◽  
Author(s):  
P. H. Nakstad ◽  
M. Haakonsen ◽  
B. Magnæs ◽  
S. Hetland
Keyword(s):  
Blood Pressure ◽  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
Left Vertebral Artery ◽  
Feeding Artery ◽  
Congenital Arteriovenous Fistula ◽  
Heart Size ◽  
Intracranial Arteries ◽  
The Right ◽  
Surgical Extirpation

A 7-year-old girl with a right-sided congenital arteriovenous fistula in the neck was admitted with signs of cardial incompensation. Her fistula was fed from the right vertebral artery in antegrade as well as retrograde directions. A steal from the intracranial arteries was established. In addition, smaller feeding arteries from the neck were found. She was operated on with ligation of the right vertebral artery proximal to the fistula but the attempted ligation of the artery cranially to the fistula was unsuccessful. She was therefore embolized by the formation of a plug of platinum fiber coils in the upper right vertebral artery. Catheterization was performed from the left vertebral artery via the basilar artery. Persisting minor feeders to the fistula from cervical arteries were embolized in a second session. Finally, surgical extirpation of the fistula was performed together with the operative ligation of a crossover feeding artery from the left vertebral artery. Her heart size, heart rate and blood pressure were successively normalized.

scholarly journals Vertebral artery dissecting aneurysm treated by internal trapping via the contralateral vertebral artery: A case report

2015 ◽  
Vol 21 (5) ◽  
pp. 576-579 ◽  
Author(s):  
Atsuhiro Kojima
Keyword(s):  
Vertebral Artery ◽  
Sudden Onset ◽  
Dissecting Aneurysm ◽  
Left Vertebral Artery ◽  
Distal Side ◽  
Consciousness Disturbance ◽  
History Of ◽  
The Right ◽  
Vertebral Artery Dissecting Aneurysm ◽  
Guiding Catheter

A 42-year-old man with a history of sudden onset of severe headache followed by consciousness disturbance was brought to our hospital. Radiological examinations revealed subarachnoid hemorrhage, associated with rupture of a left vertebral artery dissecting aneurysm. Initially, internal trapping was attempted via the ipsilateral vertebral artery. However, the microcatheter could not be navigated through the true lumen to the distal side of the vertebral artery. Subsequently, therefore, the guiding catheter was placed in the right vertebral artery, and the microcatheter was retrogradely navigated successfully through the lesion to the proximal side of the left vertebral artery. Finally, the lesion was completely embolized with electrodetachable coils without complications. However, the patient died after the operation because of deterioration of the general condition. The postmortem examination revealed how an intimal flap had interfered with the antegrade navigation of the microcatheter in the lesion. The present case showed that endovascular treatment for a vertebral artery dissecting aneurysm via the contralateral vertebral artery may be a useful option in cases where antegrade navigation of the microcatheter via the ipsilateral vertebral artery is found to be difficult.

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