Costa Matias, Basamh Mohammed, Vivanco-Suarez Juan, Casanova Daniel, Baldoncini Matias, Alobaid Abdullah, Loh Yince, Patel Akshal, McDougall Cameron G, Monteith Stephen J
Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA.
Medical Faculty, University of Valparaíso, San Felipe, Chile.
Interv Neuroradiol. 2023 Apr 18:15910199231170079. doi: 10.1177/15910199231170079.
Vertebral-venous fistulas (VVFs) are rare. Scarce literature exists to guide our understanding and management. We report our experience and propose a classification based on flow, feeder number, and involvement of accessible veins. Additionally, we include a practical treatment approach.
Retrospective chart and imaging review of cerebrovascular arteriovenous fistulas treated in our center between July 2013 and April 2022. We reviewed patient demographics, presentation, imaging, treatment strategies, and outcomes.
Nine patients with VVFs were identified, six were females. Ages ranged between 38-83 years. There were six high-flow and three low-flow. Most VVFs originated at the level of V3. Additional feeders from the internal carotid artery, external carotid artery, and/or subclavian artery were present in four cases (two were high-flow). Four cases had multiple arterial feeders. All cases were symptomatic. Origin was spontaneous in eight and iatrogenic in one case. Most common presenting symptoms were pain (7) and pulsatile tinnitus (4). Neurological deficits were present in two cases (1 high- and 1 low-flow). Four cases were treated with vertebral artery segmental sacrifice alone, three required multiple transarterial embolizations with or without VA sacrifice, one case had single transvenous approach, and one was treated with single targeted transarterial embolization. One patient had a minor transient neurological complication. No treatment-related mortality was seen.
Treatment of high-flow and symptomatic low-flow VVFs is feasible and safe. Our classification and treatment approach might help guide patient selection and choice of endovascular approach. However, our approach warrants further validation with a larger number of patients.
椎静脉瘘（VVF）较为罕见。关于指导我们对其理解和管理的文献稀缺。我们报告我们的经验，并基于血流、供血支数量以及可及静脉的受累情况提出一种分类方法。此外，我们还纳入了一种实用的治疗方法。
对2013年7月至2022年4月在我们中心接受治疗的脑血管动静脉瘘进行回顾性病历和影像学检查。我们回顾了患者的人口统计学资料、临床表现、影像学检查、治疗策略及结果。
共识别出9例VVF患者，其中6例为女性。年龄在38 - 83岁之间。有6例高流量瘘和3例低流量瘘。大多数VVF起源于V3水平。4例（2例为高流量瘘）存在来自颈内动脉、颈外动脉和/或锁骨下动脉的额外供血支。4例有多个动脉供血支。所有病例均有症状。8例起源为自发性，1例为医源性。最常见的临床表现为疼痛（7例）和搏动性耳鸣（4例）。2例（1例高流量瘘和1例低流量瘘）出现神经功能缺损。4例仅采用椎动脉节段性牺牲治疗，3例需要多次经动脉栓塞，可联合或不联合椎动脉牺牲，1例采用单纯经静脉入路，1例采用单次靶向经动脉栓塞治疗。1例患者出现轻微短暂性神经并发症。未见与治疗相关的死亡病例。
高流量和有症状的低流量VVF的治疗是可行且安全的。我们的分类和治疗方法可能有助于指导患者选择和血管内治疗方法的选择。然而，我们的方法需要更多患者进一步验证。
