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A case of iatrogenic vertebro-vertebral arteriovenous fistula treated by combination of double catheter and balloon anchoring technique.

World Neurosurg. 2019 May 07;:

Authors: Ono I, Satow T, Ito Y, Hamano E, Matsubara H, Kataoka H, Takahashi JC

Abstract
BACKGROUND: A case of high-flow cervical vertebro-vertebral arteriovenous fistula (VVAVF), which was occluded with detachable coils by transarterial/ transvenous double catheter technique and balloon anchoring technique, is reported.
CASE DESCRIPTION: A 32-year-old male who had the history of dilated cardiomyopathy, heart failure and arrhythmia under anticoagulation presented with neck bruit after the right internal jugular vein puncture. A high-flow VVAVF between the right vertebral artery (VA) and the vertebral vein (VV) was revealed by ultrasonography and angiography. To extirpate the shunt while preserving the right VA without using a stent to avoid antiplatelet therapy, double catheter technique was used to occlude the vein and the shunt tightly, one catheter from venous side and the other from the VA to the VV through the shunt. Finally, the stabilization of the coil cage in the dilating VV was secured by placing a balloon distally as an anchor and the shunt was successfully occluded with small amounts of coils only in the venous side. The shunt and cervical bruit disappeared immediately after the treatment and no recurrence was observed.
CONCLUSIONS: Double catheter technique as well as balloon anchoring technique used in this case seem effective for TVE of VVAVF when preservation of the VA is desired.

PMID: 31075492 [PubMed – as supplied by publisher]

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