Endovascular management of traumatic cervicothoracic arteriovenous fistula.
BACKGROUND
This study evaluated a single-centre experience with endovascular repair of traumatic arteriovenous fistula in the cervicothoracic region.


METHODS
Endovascular repair of 27 traumatic cervicothoracic arteriovenous fistulas was attempted between August 1998 and December 2001. Patients with active bleeding or end-organ ischaemia were excluded. Follow-up was accomplished with clinical, duplex Doppler and arteriographic evaluation after 1 month and then every 3 months.


RESULTS
Twelve patients with a major vessel injury were treated by stent-graft placement. Vessels involved were the subclavian (eight), common carotid (three) and internal carotid (one) arteries. Subclavian artery side branches were embolized in three of the eight patients. Four patients developed early type 4 endoleaks but all resolved. Treatment with stent-grafts was ultimately successful in all 12 patients. Three patients were lost to follow-up. During mean follow-up of 21 (range 3-36) months, one of the remaining patients developed a graft stenosis. Fifteen patients with minor vessel injuries were treated with arterial embolization. Vessels embolized were subclavian artery branches (four), external carotid artery and branches (seven) and vertebral arteries (four). Successful embolization was accomplished in ten of 15 patients.


CONCLUSIONS
Endovascular therapy is a promising alternative to surgery for selected patients with cervicothoracic arteriovenous fistula.
du Toit
D F
DF
Department of Surgery, Tygerberg Hospital and the University of Stellenbosch, Tygerberg, South Africa.
Leith
J G
JG
Strauss
D C
DC
Blaszczyk
M
M
Odendaal
J de V
Jde V
Warren
B L
BL
D000293:Adolescent; D000328:Adult; D001158:Arteries / Q000293:injuries; D001164:Arteriovenous Fistula / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D020212:Carotid Artery Injuries / Q000628:therapy*; D017536:Carotid Artery, Common; D002343:Carotid Artery, Internal; D002648:Child; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019838:Neck Injuries / Q000209:etiology / Q000628:therapy; D015607:Stents; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000628:therapy; D014951:Wounds, Stab / Q000628:therapy