title: Successful Treatment of a Ruptured Extracranial Vertebral Artery Aneurysm with Onyx Instillation.
abstract: The rupture of an extracranial vertebral artery aneurysm has only been rarely described in the literature and treatment options are therefore not standardized. Here we report the successful endovascular repair of a spontaneously ruptured extracranial left vertebral artery aneurysm using Onyx instillation. A 48-year-old woman was transferred to our clinic after having been intubated due to a massive hematoma of the left neck. A contrast-enhanced computed tomography (CT) showed a rupture of the left extracranial vertebral artery. Several issues complicated the therapeutic decision making in this rare case: first, the patient showed multiple aneurysms in CT angiography; therefore a connective tissue disease could not be excluded. Furthermore, as anamnestic work-up revealed that several episodes of postoperative bleeding and open surgery at this anatomic location are rarely performed, risks for postoperative complications were high. Therefore, the patient was hemodynamically stabilized and the ruptured aneurysm was treated in an endovascular approach with Onyx instillation and coil embolization. Complete exclusion of the aneurysm was achieved without periprocedural or neurological complications. Successful repair was confirmed by CT angiography on the first postoperative day as well as 12 months after the intervention. In conclusion, this case shows that endovascular Onyx embolization of ruptured vertebral aneurysms is a save and feasible method.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Kollmann
authors.affiliation: Department of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Kinstner
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Katharina
authors.initials: K
authors.lastname: Teleky
authors.affiliation: Department of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Wressnegger
authors.affiliation: Department of Internal Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Renate
authors.initials: R
authors.lastname: Koppensteiner
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Ihor
authors.initials: I
authors.lastname: Huk
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Medical University of Vienna, Vienna, Austria. Electronic address: christoph.neumayer@meduniwien.ac.at.
authors.forename: Christoph
authors.initials: C
authors.lastname: Neumayer
authors.affiliation: Department of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Funovics
mesh_terms: D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D000072226:Computed Tomography Angiography; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D011145:Polyvinyls / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide