title: Anatomically based approach for endovascular treatment of vertebro-vertebral arteriovenous fistula.
abstract: Vertebro-vertebral arteriovenous fistula (VV-AVF) is a rare vascular disorder with an abnormal high-flow shunt between the extracranial vertebral artery (VA), its muscular or radicular branches and an adjacent vein. To date, there are no guidelines on the best treatment for VV-AVF. We present our experience of VV-AVF treatment with covered stents in three patients and detachable coils in two patients. One patient with fistula at the V3 segment had rapid fistula recurrence one week after covered stent treatment. The possible causes of failed treatment in this patient are discussed. The currently available treatment modalities for VV-AVF are also summarized after a literature review. At the end of this article, we propose a new concept of anatomically based approach for endovascular treatment of VV-AVF. Fistula in the V1-2 segments of vertebral artery could be treated safely and effectively by covered stent with the benefit of preserving VA patency. Embolization with variable embolizers should be considered first for fistula in the V3 segment because of the tortuous course and flexibility of the VA in this segment.
authors.affiliation: Department of Diagnostic Radiology, Chang Gung Memorial Hospital; Keelung, Taiwan - Division of Neuroradiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital; Linkou, Taiwan - College of Medicine and School of Medical Technology, Chang Gung University; Taoyuan, Taiwan - hfwong@cgmh.org.tw; hfwong4720@gmail.com.
authors.forename: Chih-Hua
authors.initials: CH
authors.lastname: Yeh
authors.affiliation: Department of Diagnostic Radiology, Chang Gung Memorial Hospital; Keelung, Taiwan - Division of Neuroradiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital; Linkou, Taiwan - College of Medicine and School of Medical Technology, Chang Gung University; Taoyuan, Taiwan.
authors.forename: Yao-Liang
authors.initials: YL
authors.lastname: Chen
authors.affiliation: Division of Neuroradiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital; Linkou, Taiwan - College of Medicine and School of Medical Technology, Chang Gung University; Taoyuan, Taiwan.
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Wu
authors.affiliation: Department of Diagnostic Radiology, Chang Gung Memorial Hospital; Keelung, Taiwan - Division of Neuroradiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital; Linkou, Taiwan - College of Medicine and School of Medical Technology, Chang Gung University; Taoyuan, Taiwan.
authors.forename: Yu-Chieh
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Division of Neuroradiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital; Linkou, Taiwan - College of Medicine and School of Medical Technology, Chang Gung University; Taoyuan, Taiwan.
authors.forename: Ho-Fai
authors.initials: HF
authors.lastname: Wong
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D001164:Arteriovenous Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D014012:Tinnitus / Q000209:etiology; D016896:Treatment Outcome; D014711:Vertebral Artery
keywords: arteriovenous fistula; stent; therapeutic embolization; vertebral artery