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(a) and (b) Preoperative vertebral angiogram right anterior oblique (a) and anteroposterior (b) views showing an arteriovenous fistula (indicated by arrow) at the level of C1, with no obstruction of the left vertebral artery. (c) Postoperative vertebral angiogram anteroposterior view shows no evidence of fistula.
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The CTA also demonstrated multiple dilated and serpiginous vessels surrounding the right vertebral artery at the level of C1 and opacification of the right internal jugular vein and epidural venous plexus on the right, suggesting a potential arteriovenous fistula (AVF) involving the right vertebral artery (Figures 1(a) and 1(b)). On day two of admission, she underwent balloon test occlusion followed by endovascular sacrifice of the right vertebral artery and coil embolization of the fistulous communication (Figure 1(c)).