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NI FEATURE: THE FIRST IMPRESSION
Year : 2023  |  Volume : 71  |  Issue : 5  |  Page : 871

Vertebral Arterio-Venous Fistulas


Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India

Date of Submission09-Oct-2023
Date of Decision09-Oct-2023
Date of Acceptance09-Oct-2023
Date of Web Publication18-Oct-2023

Correspondence Address:
Sanjeev Kumar
Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.388121

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How to cite this article:
Kumar S. Vertebral Arterio-Venous Fistulas. Neurol India 2023;71:871

How to cite this URL:
Kumar S. Vertebral Arterio-Venous Fistulas. Neurol India [serial online] 2023 [cited 2023 Dec 7];71:871. Available from: https://www.neurologyindia.com/text.asp?2023/71/5/871/388121




The vertebral Arterio-venous fistulas are rare and direct communications between the extradural segment of the vertebral artery and paravertebral venous plexus. They may arise spontaneously or, more commonly, after mechanical injury. Most cases present with bruit, and in severe cases, the engorged vein may compress the cord, producing compressive myelopathy and radiculopathy. Neurological symptoms are also contributed by hypertensive venopathy.

Endovascular intervention is the preferred mode of treatment, while open surgery is reserved for failed endovascular interventions. The ideal goal is the selective occlusion of the fistulous communication and preservation of the parent vessel flow. This is possible only when the fistulous communications are single or very few with clear demarcation on the angiogram. The interventional approach may be trans-arterial, trans-venous or combined. In cases where fistulas are multiple and unclear, the parent vessel may be occluded. The contralateral vertebral artery's patency should be ensured first with a balloon occlusion test before the sacrifice of the parent artery.

The first illustration depicts the anatomy of the multiple vertebral arterio-venous fistulas in the anteroposterior view. The second illustration shows the endovascular treatment by parent vessel occlusion with the coils. The balloon is placed distal to the fistulas to prevent coil migration. The reversal of the venous congestion is illustrated. The thecal sac is shown to regain its position, which happens slowly over time.

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