PMC4329681_01
(A) CT scan demonstrating defect in the pedicle due to erosion (B) MRI demonstrating the fistula with large flow voids with features of venous hypertension as suggested by high T2 signals in the cervicomedullary junction in the second panel
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F1
CT scan showed erosion of the right pedicle [Figure 1A] of C4 vertebra. MRI demonstrated large areas of flow void extending from C4 to C6 with cord compression [Figure 1B].
(A) Right subclavian artery angiogram demonstrating the VV AVF supplied by right vertebral artery (B) VV AVF additionally supplied through right ascending cervical artery
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F2
DSA demonstrated a high-flow vertebrovertebral arteriovenous fistula (VV AVF) connecting the right vertebral artery (VA) at its origin to the vertebral venous plexus [Figure 2A]. There were multiple intersegmental collaterals bilaterally, supplied via right ascending cervical arteries [Figure 2B].
(A) Coiling from right vertebral artery access, (B) Access of the fistula from left VA through vertebrobasilar junction, (C) Post embolization vertebral and brachiocephalic angiogram demonstrating complete cure of the fistula, (D) Coil mass in the fistula
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F3
The fistula was coiled by placing Axium 20 x 50 cm (ev3 Endovascular, Inc, Plymouth, MN, USA) as the first coil [Figure 3A]. The fistula was cannulated from the left VA through the vertebrobasilar junction into the right VA with the combination of Echelon 14 microcatheter with Xpedion 14 microwire [Figure 3B]. The check angiogram demonstrated complete exclusion of the fistula from the circulation [Figure 3C]. The final angiogram from the left VA and right subclavian artery demonstrated complete cure of the fistula with stable coil and glue mass [Figure 3D].