Spontaneous Vertebral Artery Arteriovenous Fistula with Neurofibromatosis Type I and Its Management with Covered Stent

Abstract

Vertebro-vertebral fistulas (VVFs) are uncommon vascular pathology. It can be either primary (spontaneous) or secondary (iatrogenic or mechanical trauma). Spontaneous vertebral arteriovenous malformation is often associated with connective tissue disorders. Cases associated with neurofibromatosis type I (NF I) are even rarer. Management of VVF with covered stent is an emerging option for construction of vertebral artery. It not only preserves the flow of the parent artery but also has immediate exclusion of the fistula from the parent artery. A 30-year-old pregnant female patient presented with cervical bruit and left upper limb radiculopathy. She was a known case of NF I. Magnetic resonance imaging cervical spine revealed multiple flow voids compressing the cervical spinal cord and nerve roots. Digital subtraction angiography revealed a vertebral artery arteriovenous fistula. She underwent endovascular treatment in the form of a covered stent. Her clinical symptoms immediately improved. She was asymptomatic at the 1-year follow-up.

Keywords

spontaneous vertebral artery arteriovenous fistula - neurofibromatosis - endovascular treatment - covered stent - arteriovenous malformation

Publikationsverlauf

Artikel online veröffentlicht:
31. August 2023

• References

• 1 Kāhārā V, Lehto U, Ryymin P, Helén P. Vertebral epidural arteriovenous fistula and radicular pain in neurofibromatosis type I. Acta Neurochir (Wien) 2002; 144 (05) 493-496
• 2 Yoshida S, Nakazawa K, Oda Y. Spontaneous vertebral arteriovenous fistula–case report. Neurol Med Chir (Tokyo) 2000; 40 (04) 211-215
• 3 Chen C, Wu Y, Zhao K, Duan G, Liu J, Huang Q. Endovascular treatment of vertebro-vertebral arteriovenous fistula in neurofibromatosis type I: a report of two cases and literature review with a focus on endovascular treatment. Clin Neurol Neurosurg 2021; 207: 106806
• 4 Deans WR, Bloch S, Leibrock L, Berman BM, Skultety FM. Arteriovenous fistula in patients with neurofibromatosis. Radiology 1982; 144 (01) 103-107
• 5 Ishigami D, Koizumi S, Ishikawa O. et al. Embolization of dural arteriovenous fistula during twin pregnancy - a case report and literature review. Interv Neuroradiol 2021; 27 (05) 658-662
• 6 Dote K, Takahashi N, Niki T, Ishiguro T, Shiojima I. A case of vertebral arteriovenous fistula in a patient undergoing maintenance hemodialysis. Renal Replacement Therapy 2018; 4 (01) 1-7
• 7 Peeters FL. Endovascular treatment of spontaneous vertebro-vertebral fistulas. Röfo Fortschr Geb Röntgenstr Neuen Bildgeb Verfahr 1990; 153 (06) 724-725
• 8 Briganti F, Tedeschi E, Leone G. et al. Endovascular treatment of vertebro-vertebral arteriovenous fistula. A report of three cases and literature review. Neuroradiol J 2013; 26 (03) 339-346
• 9 Edwards MK, Christenson EN, Corliss BM, Polifka AJ, Allen BR. Vertebral arteriovenous fistula: an unwelcome thrill. Case Rep Emerg Med 2017; 8386459
• 10 Aljobeh A, Sorenson TJ, Bortolotti C, Cloft H, Lanzino G. Vertebral arteriovenous fistula: a review article. World Neurosurg 2019; 122: e1388-e1397
• 11 Paolini S, Colonnese C, Galasso V. et al. Extradural arteriovenous fistulas involving the vertebral artery in neurofibromatosis Type 1. J Neurosurg Spine 2008; 8 (02) 181-185
• 12 Okata T, Ishii A, Sadamasa N. et al. Successful endovascular treatment with covered stent for iatrogenic vertebral arteriovenous fistula. J Neuroendovasc Therapy 2018; 12 (01) 29-37
• 13 Geng J, Hu P, Ma Y, Zhang P, Zhang H. Endovascular treatment of V3 segment vertebro-vertebral arteriovenous fistula with Willis covered stent: case report and literature review. Interv Neuroradiol 2019; 25 (01) 97-101