Percutaneous management of concomitant post-traumatic high vertebrovertebral and caroticojugular fistulas using balloons, coils, and a covered stent.
OBJECTIVE
To describe the endovascular management of vertebrovertebral and caroticojugular fistulas in the same patient using a combination of endovascular techniques including covered stent placement in the high extracranial internal carotid artery.


METHODS
A 22-year-old man presented with ipsilateral vertebrovertebral and caroticojugular fistulas at the C1 level several weeks after sustaining a solitary penetrating knife injury below the right ear. The right vertebral artery was sacrificed after a failed endovascular attempt to close the vertebrovertebral fistula. The caroticojugular fistula was treated with a self-expanding covered stent (Wallgraft) with exclusion of the fistula and preservation of flow through the carotid artery.


CONCLUSIONS
Preservation of the extracranial arteries should be the preferred goal of treatment in traumatic extracranial arteriovenous fistulas. The use of covered stents in the extracranial vessels can accomplish this goal.
Duncan
Ian C
IC
Unitas Interventional Unit, Centurion, South Africa. docdunc@iafrica.com
Fourie
Pieter A
PA
D000328:Adult; D001164:Arteriovenous Fistula / Q000209:etiology* / Q000601:surgery*; D020212:Carotid Artery Injuries / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007601:Jugular Veins / Q000293:injuries* / Q000601:surgery*; D008297:Male; D015607:Stents; D014656:Vascular Surgical Procedures / Q000295:instrumentation; D014711:Vertebral Artery / Q000293:injuries* / Q000601:surgery*; D014950:Wounds, Penetrating / Q000150:complications*