Author’s Response to the “Letter to the Editor” Submitted by Dr Trager and Dr Mattox Regarding “An Unusual Suspect for a Traumatic Arteriovenous Fistula in the Left Vertebral Artery”

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.

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

Neurosurgery ◽

10.1227/00006123-198402000-00020 ◽

1984 ◽

Vol 14 (2) ◽

pp. 225-229 ◽

Cited By ~ 31

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.

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Retrograde leptomeningeal venous approach for dural arteriovenous fistulas at foramen magnum

Interventional Neuroradiology ◽

10.1177/1591019915582942 ◽

2015 ◽

Vol 21 (2) ◽

pp. 244-248 ◽

Cited By ~ 3

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.

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

The Journal of Vascular Access ◽

10.1177/1129729818761279 ◽

2018 ◽

Vol 19 (4) ◽

pp. 404-408 ◽

Cited By ~ 3

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.

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Combined endovascular and surgical treatment in vertebral arteriovenous fistula

Acta Radiologica ◽

10.1080/02841859709171237 ◽

1997 ◽

Vol 38 (1) ◽

pp. 25-29 ◽

Cited By ~ 2

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.

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Spontaneous Regression of an Arteriovenous Fistula Between Paravertebral Venous Plexus and the Vertebral Artery: A Rare Case Report

10.21203/rs.3.rs-115343/v1 ◽

2020 ◽

Author(s):

Zhiqiang Yu ◽

Guangxu Zhang ◽

Xingcheng Bai ◽

Jinbing Zhao ◽

Jun Ma

Keyword(s):

Vertebral Artery ◽

Arteriovenous Fistula ◽

Spontaneous Regression ◽

Guide Wire ◽

Left Vertebral Artery ◽

Venous Plexus ◽

Early Application ◽

Atorvastatin Calcium ◽

Arteriovenous Fistulas ◽

Delayed Recognition

Abstract Background: Spontaneous regression of huge vertebral arteriovenous fistula (AV fistulas) due to acupuncture procedure is a rare phenomenon. The clinical presentations, management, prognosis of this type arteriovenous fistula has been rarely reported. In addition, we exclusively analyzed the possible reasons for its spontaneous regression.Case presentation: A 57-year-old Chinese woman presented with a 2-month history of progressively worsening headache and high-pitched tinnitus after acupuncture and massage in the neck and the left mastoid region. Later Digital Subtraction Angiography (DSA) confirmed the presence of arteriovenous fistulas at cervical 2-3 (C2-3) level, lying between the paravertebral venous plexus and the left vertebral artery. The patient had a background of hypertension, hypothyroidism and hysterectomy. The arteriovenous fistulas disappeared mysteriously, possibly because of the motion of the left vertebral artery and the compression of guide wire against the blood vessel wall. The patient recovered well following conservative treatment of taking atorvastatin calcium tablets (20mg/day), despite delayed recognition and invasive investigation.Conclusion: Adequate evaluation and standardized procedures with Doppler may minimize the associated risks while performing acupuncture. Early application of vascular examination should be considered in patients with typical high-pitched tinnitus and medical history associated with acupuncture treatment. Statins are effective in repairing the lining of blood vessels.

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A Challenging Problem

Interventional Neuroradiology ◽

10.1177/159101990601200213 ◽

2006 ◽

Vol 12 (2) ◽

pp. 171-175 ◽

Cited By ~ 4

Author(s):

A. Kurt ◽

A. Tanrivermiş ◽

A. İpek ◽

Ö. Tosun ◽

M. Gümüş ◽

...

Keyword(s):

Vertebral Artery ◽

Arteriovenous Fistula ◽

Jugular Vein ◽

Penetrating Trauma ◽

Covered Stent ◽

Left Vertebral Artery ◽

Conventional Angiography ◽

Pseudoaneurysm Formation ◽

Arteriovenous Fistulas ◽

Pulsatile Mass

Vertebral pseudoaneurysm and arteriovenous fistulas are very rare and are commonly due to penetrating trauma to craniocervical region. A 20-year-old man was presented with progressive swelling and pulsatile mass on the left side of his face. He had been stabbed two weeks ago on the left side of his face. Doppler Ultrasound revealed large left vertebral pseudoaneursym and arteriovenous fistulisation with the ipsilateral internal jugulat vein. MR Angiography and conventional angiography confirmed arteriovenous fistula between left vertebral artery and ipsilateral internal jugular vein and large pseudoaneurysm formation on vertebral artery. Arteriovenous fistula was closed surgically and embolized with surgicell. But the pseudoaneurysm was treated with endovascular covered stent placement.

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Angiographic evidence of spontaneous closure of nontraumatic arteriovenous fistula of the vertebral artery

Journal of Neurosurgery ◽

10.3171/jns.1973.38.5.0658 ◽

1973 ◽

Vol 38 (5) ◽

pp. 658-661 ◽

Cited By ~ 11

Author(s):

Young H. Kim ◽

Philip L. Gildenberg ◽

Paul M. Duchesneau

Keyword(s):

Vertebral Artery ◽

Arteriovenous Fistula ◽

Spontaneous Closure ◽

Left Vertebral Artery ◽

Content Type ◽

Congenital Arteriovenous Fistula ◽

Angiographic Evidence ◽

Fine Print

✓ A case is reported in which a congenital arteriovenous fistula of the left vertebral artery closed spontaneously 4 years after becoming symptomatic. The course was followed and confirmed by retrograde left brachial angiography.

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