Yeh Chih-Hua, Chen Yao-Liang, Wu Yi-Ming, Huang Yu-Chieh, Wong Ho-Fai
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 -
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.
Interv Neuroradiol. 2014 Dec;20(6):766-73. doi: 10.15274/INR-2014-10072. Epub 2014 Dec 5.
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.
椎-椎动静脉瘘(VV-AVF)是一种罕见的血管疾病,表现为颅外椎动脉(VA)及其肌支或神经根分支与相邻静脉之间存在异常的高流量分流。迄今为止,尚无关于VV-AVF最佳治疗方法的指南。我们介绍了3例采用覆膜支架和2例采用可脱卸弹簧圈治疗VV-AVF的经验。1例V3段瘘患者在覆膜支架治疗1周后瘘迅速复发。讨论了该患者治疗失败的可能原因。在文献复习后,还总结了目前可用的VV-AVF治疗方式。在本文结尾,我们提出了一种基于解剖学方法的VV-AVF血管内治疗新概念。椎动脉V1-2段的瘘可通过覆膜支架安全有效地治疗,且有利于保持VA通畅。由于V3段VA走行迂曲且具有可弯曲性,对于该段的瘘应首先考虑使用不同的栓塞剂进行栓塞。