Traumatic vertebral artery to jugular vein arteriovenous fistula

Case contributed by Andrew Dixon


Stabbed to neck. Assess for vascular injury.

Patient Data

Age: 20
Gender: Male

Stab injury to the right side of the neck where locules of gas are evident. At the C7 level there is extravasation of contrast from the right vertebral artery with the contrast passing anterolaterally from the artery into the right internal jugular vein (traumatic arteriovenous fistula). 

Selective catheterization of the left vertebral artery with 5-French guiding catheter demonstrates a normal appearance of this vertebral artery with retrograde filling of the right cervical vertebral artery down to the level of C7.  There is fistula is demonstrated to the internal jugular vein.  

Subsequent catheterization of the right subclavian artery demonstrates a normal origin of the vertebral artery with fistula again seen.  The vertebral artery distal to the fistula cannot be visualized.  5000 units of IV heparin were administered and 300 mg of aspirin given through the orogastric tube.  The vertebral artery was selectively catheterized with the 5-French guiding catheter and the artery probed with a micro catheter and micro guide wire.  Access could be gained to the distal vertebral artery with some difficulty.  The 5-French guiding catheter was exchanged for a Neuron Max guiding catheter and a Graftmaster balloon expanding covered stent (Abbott Vacular) measuring 4 x 19 mm successfully deployed with exclusion of the fistula and patency restored to the vertebral artery.  

Case Discussion

A case of traumatic right vertebral artery to internal jugular vein arteriovenous fistula. The fistula was stealing flow for the left vertebral artery and posterior circulation retrogradely down the right vertebral artery. This was successfully treated via endovascular approach with stent occlusion. 

With thanks to Dr Anoop Madan.

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