endovascular occlusion

INTRODUCTION: Vertebro-vertebral arteriovenous fistulas (VVFs) are abnormal communications between the extracranial vertebral artery and one or multiple neighboring veins. We report an unusual case of a 72-year old woman with a single high-flow VVF between the left vertebral artery and the significantly dilated surrounding epidural venous plexus, located in the intervertebral foramina at the C2 level, after a craniocervical blunt injury, manifesting as progressive severe left arm paresis. METHODS: From a transarterial approach, the fistula venous site was selected with a microcatheter, and several Guglielmi detachable coils were deployed inside the venous part up to the fistula orifice until complete VVF occlusion was obtained maintaining the left vertebral arterial patency. RESULTS: Muscle strength of patient’s left arm improved completely. CONCLUSION: Endovascular selective occlusion of the VVFs is the treatment of choice and every effort should be made to preserve parent vessel patency according to fistula’s angioarchitecture and physician’s technical experience.