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AJNR - American Journal of Neuroradiology

Published ahead of print on May 22, 2008
doi: 10.3174/ajnr.A1123

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Endovascular Treatment of Traumatic Injuries of the Vertebral Artery

D.A. Herrera^a, S.A. Vargas^a and A.B. Dublin^b

^a Department of Radiology, Neuroradiology Section, Universidad de Antioquia, Hospital Universitario San Vicente de Paul, Medellin, Colombia
^b Department of Radiology, Neuroradiology Section, UC Davis Medical Center, Sacramento, Calif

View larger version (27K): [in this window] [in a new window]   Fig 1. Schematic representation of a vertebral arteriovenous fistula with steal phenomenon. Arrows represent blood-flow direction. A, Blood flow from both vertebral arteries is directed to the fistula site (double thin arrows). B, Trapping technique with positioning of detachable balloons (arrowheads) proximal and distal to the arteriovenous communication re-establishes normal flow through the basilar artery.

View larger version (98K): [in this window] [in a new window]   Fig 2. Traumatic arteriovenous fistula caused by detonation with propelled metal fragments (asterisks) penetrating the neck. A, Left vertebral arteriovenous fistula is identified with both ascending and descending venous drainage. B, There is steal phenomenon represented by filling of the fistula through the right vertebral artery. C, Fistula trapping has been performed with proximal (arrows) and distal (circle) balloon detachment. Note occlusion of the fistula with re-establishment of normal flow in the right vertebral artery.

View larger version (124K): [in this window] [in a new window]   Fig 3. Right vertebral arteriovenous fistula after a stab wound injury of the neck. A, Prominent ascending and descending venous drainage with the presence of pseudoaneurysm (arrow) is noted. B, Uncovered stent deployment with coiling (arrowheads) was performed. There is partial occlusion of the pseudoaneurysm and reduction in venous drainage in the immediate postreatment angiographic images. C, Angiographic control image 18 months after treatment shows normal flow through the right vertebral artery without evidence of fistula or pseudoaneurysm. D, Reconstructive endovascular approach by using a stent (double arrows) and coils (arrowhead) was accomplished. E, Transverse T1-weighted MR image demonstrates the right vertebral AVF compressing the cervical spinal cord (arrow). F, MR control image 18 months after treatment shows AVF thrombosis (arrow) and patency of the right vertebral artery (arrowhead).