Neurointervention.  2023 Nov;18(3):200-203. 10.5469/neuroint.2023.00430.

Vertebro-Vertebral Fistula Occlusion Using a Woven EndoBridge^TM-Device

• Dahl RH
• Ghasemi-Rad M
• Eskesen V
• Frevert SC
• Sølling C
• Benndorf G

• KMID: 2547283
• DOI: http://doi.org/10.5469/neuroint.2023.00430

Abstract

Vertebro-vertebral fistulas (VVFs) are vascular lesions that may develop after trauma or spontaneously in association with connective tissue disorders. We present a rare case of a post-traumatic VVF in a young patient presenting with a painless swelling and a bruit in her left upper neck. Digital subtraction angiography showed an arteriovenous fistula between the left vertebral artery (VA) and the vertebral venous plexus with significant steal phenomenon. Endovascular therapy was performed using a Woven EndoBridge^TM (WEB)-device combined with coils that allowed preservation of the VA. The patient fully recovered from her symptoms and follow-up imaging showed stable occlusion. In conclusion, VVFs can be effectively treated using intrasaccular flow diverters such as the WEB-device, allowing for complete and stable occlusion while preserving the parent artery.

Keyword

Therapeutic embolization; Vertebral artery; Arteriovenous fistula; WEB-device; Woven EndoBridge-device

Figure

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  Fig. 1. (A) Left vertebral artery (VA) injection reveals a high-flow vertebro-vertebral fistula (VVF) with significant steal phenomenon and no antegrade flow in the left V4-segment. The fistulous point is marked with an asterisk. The extracranial left VA (arrow) and downstream venous system are dilated. (B) Right VA injection shows flow reversal in the left V4-segment of the VA. The fistulous point is marked with an asterisk. (C) Volume-rendered three-dimensional reconstruction from a left VA (short arrow) injection in left lateral view with a clip-plane close to the fistulous point (asterisk and long arrows). The fistulous point measured approximately 5.5 mm×6.3 mm in diameter. There is extensive filling of the vertebral venous plexus and paraspinal veins. (D) Multiplanar reconstruction of a cone-beam computed tomography with a left VA (arrow) injection shows the fistulous point (asterisk) between the V3-segment of the VA and the vertebral venous plexus. (E) Early phase left VA (arrow) injection shows the fistulous connection (asterisk) between the VA and proximal venous drainage. (F) Detachable coils (arrowheads) provided a scaffold for deployment of the Woven EndoBridgeTM-device (MicroVention) (asterisk). Catheter in the left VA (arrow). (G) Control runs with left VA (arrow) injection shows complete occlusion of the VVF. The left VA is preserved. (H) Follow-up digital subtraction angiography after 5.5 months shows persistent occlusion of the fistula. The left VA (arrow) is patent and has a normal caliber.

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