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

Author(s):  
Zhiqiang Yu ◽  
Guangxu Zhang ◽  
Xingcheng Bai ◽  
Jinbing Zhao ◽  
Jun Ma

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.

2015 ◽  
Vol 21 (2) ◽  
pp. 244-248 ◽  
Author(s):  
George AC Mendes ◽  
François Caire ◽  
Suzana Saleme ◽  
Sanita Ponomarjova ◽  
Charbel Mounayer

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.


2015 ◽  
Vol 8 (6) ◽  
pp. 643-647 ◽  
Author(s):  
Ramsey Ashour ◽  
Darren B Orbach

A vertebral-epidural spinal arteriovenous fistula (AVF) is an abnormal arteriovenous shunt connecting the vertebral artery to the spinal epidural venous plexus, and may occur spontaneously or secondary to a variety of causes. These unique lesions are uncommon in adults and rarer still in children. Previous reports have grouped together a heterogeneous collection of such arteriovenous lesions, including arterial contributions from the upper and lower vertebral artery, with venous drainage into a variety of spinal and paraspinal collectors. Here, through two cases, we delineate a distinct entity, the lower vertebral-to-epidural AVF. The salient clinical and anatomic features are summarized and contextualized within the broader constellation of vertebrovertebral AVF, the utility of a transarterial intravenous/retrograde intra-arterial endovascular approach is highlighted, and a new use of the Penumbra Occlusion Device (Penumbra Inc) for this purpose is reported.


2006 ◽  
Vol 12 (2) ◽  
pp. 171-175 ◽  
Author(s):  
A. Kurt ◽  
A. Tanrivermiş ◽  
A. İpek ◽  
Ö. Tosun ◽  
M. Gümüş ◽  
...  

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.


2020 ◽  
Vol 44 (1) ◽  
pp. 28-31
Author(s):  
Cassey Y. Noh

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.


2017 ◽  
Vol 60 (2) ◽  
pp. 221-223 ◽  
Author(s):  
Omar Choudhri ◽  
Mircea C. Dobre ◽  
Abdullah Feroze ◽  
Nikhil Sharma ◽  
Huy M. Do

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 ◽  
...  

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.


1993 ◽  
Vol 79 (4) ◽  
pp. 589-591 ◽  
Author(s):  
Andrea L. Halliday ◽  
Christopher S. Ogilvy ◽  
Robert M. Crowell

✓ True intracranial arteriovenous fistulas are rare. The authors report a case of a direct fistula between the intracranial portion of the vertebral artery and the lateral medullary venous system. The patient initially presented with a subarachnoid hemorrhage. An open surgical approach with clip obliteration of the lesion was used. The anatomy of this lesion and its surgical management are described.


1995 ◽  
Vol 4 (3) ◽  
pp. 303-306
Author(s):  
Takashi Kobayashi ◽  
Naoya Kuwayama ◽  
Kazumasa Yamatani ◽  
Michiharu Nishijima ◽  
Shunro Endo ◽  
...  

2018 ◽  
Vol 19 (4) ◽  
pp. 404-408 ◽  
Author(s):  
Yoko Kaneko ◽  
Takamoto Yanagawa ◽  
Yoshinori Taru ◽  
Sonoko Hayashi ◽  
Hong Zhang ◽  
...  

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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