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<meta name="DC.Title" content="Treatment of Vertebral Arteriovenous Fistulas" />
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<meta name="DC.Description" content="Twenty patients with vertebral arteriovenous fistulas (eight spontaneous, six traumatic without vertebral artery transection, and six traumatic with vertebral artery transection) were treated by transvascular embolization techniques, resulting in complete fistula closure in all patients. The fistulas were located at C1–C2 in 45%, C2–C3 in 25%, C4–C5 in 15%, C5–C6 in 10%, and C6–C7 in 5%. Trauma was the most common cause: 30% followed knife wounds, 20% followed gunshot injuries, and 10% followed blunt trauma. Eight patients had spontaneous fistulas, two associated with fibromuscular dysplasia. Three patients—all with large, long-standing fistulas—developed neurologic deficits coincident with the abrupt closure of the fistula, which resolved with reestablishment of fistula flow. Two of these patients were treated by staged closure; the other one by gradual closure. In all three cases the result was complete fistula closure without neurologic sequelae. The remaining spontaneous fistulas were all closed by balloon embolization with preservation of the vertebral artery and without deficits. The six patients with traumatic fistulas without transection were cured by balloon embolization, without deficits; in four there was also preservation of vertebral flow. The other six patients had traumatic fistulas with transection and were all cured by balloon embolization with preservation of flow in two. Four patients required bilateral approaches to the fistula to achieve complete fistula closure. The only complication was a mild residual Wallenberg syndrome after occlusion of the posterior inferior cerebellar artery in the treatment of a transection located at C1.

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<meta name="citation_abstract" lang="en" content="&lt;p&gt;Twenty patients with vertebral arteriovenous fistulas (eight spontaneous, six traumatic without vertebral artery transection, and six traumatic with vertebral artery transection) were treated by transvascular embolization techniques, resulting in complete fistula closure in all patients. The fistulas were located at C1–C2 in 45%, C2–C3 in 25%, C4–C5 in 15%, C5–C6 in 10%, and C6–C7 in 5%. Trauma was the most common cause: 30% followed knife wounds, 20% followed gunshot injuries, and 10% followed blunt trauma. Eight patients had spontaneous fistulas, two associated with fibromuscular dysplasia. Three patients—all with large, long-standing fistulas—developed neurologic deficits coincident with the abrupt closure of the fistula, which resolved with reestablishment of fistula flow. Two of these patients were treated by staged closure; the other one by gradual closure. In all three cases the result was complete fistula closure without neurologic sequelae. The remaining spontaneous fistulas were all closed by balloon embolization with preservation of the vertebral artery and without deficits. The six patients with traumatic fistulas without transection were cured by balloon embolization, without deficits; in four there was also preservation of vertebral flow. The other six patients had traumatic fistulas with transection and were all cured by balloon embolization with preservation of flow in two. Four patients required bilateral approaches to the fistula to achieve complete fistula closure. The only complication was a mild residual Wallenberg syndrome after occlusion of the posterior inferior cerebellar artery in the treatment of a transection located at C1.&lt;/p&gt;&lt;p&gt;In our opinion, transvascular techniques are the treatment of choice for vertebral arteriovenous fistulas.&lt;/p&gt;" />
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<meta name="twitter:title" content="Treatment of Vertebral Arteriovenous Fistulas" />
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<meta name="twitter:description" content="Twenty patients with vertebral arteriovenous fistulas (eight spontaneous, six traumatic without vertebral artery transection, and six traumatic with vertebral artery transection) were treated by transvascular embolization techniques, resulting in complete fistula closure in all patients. The fistulas were located at C1–C2 in 45%, C2–C3 in 25%, C4–C5 in 15%, C5–C6 in 10%, and C6–C7 in 5%. Trauma was the most common cause: 30% followed knife wounds, 20% followed gunshot injuries, and 10% followed blunt trauma. Eight patients had spontaneous fistulas, two associated with fibromuscular dysplasia. Three patients—all with large, long-standing fistulas—developed neurologic deficits coincident with the abrupt closure of the fistula, which resolved with reestablishment of fistula flow. Two of these patients were treated by staged closure; the other one by gradual closure. In all three cases the result was complete fistula closure without neurologic sequelae. The remaining spontaneous fistulas were all closed by balloon embolization with preservation of the vertebral artery and without deficits. The six patients with traumatic fistulas without transection were cured by balloon embolization, without deficits; in four there was also preservation of vertebral flow. The other six patients had traumatic fistulas with transection and were all cured by balloon embolization with preservation of flow in two. Four patients required bilateral approaches to the fistula to achieve complete fistula closure. The only complication was a mild residual Wallenberg syndrome after occlusion of the posterior inferior cerebellar artery in the treatment of a transection located at C1.

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<meta name="og-description" property="og:description" content="Twenty patients with vertebral arteriovenous fistulas (eight spontaneous, six traumatic without vertebral artery transection, and six traumatic with vertebral artery transection) were treated by transvascular embolization techniques, resulting in complete fistula closure in all patients. The fistulas were located at C1–C2 in 45%, C2–C3 in 25%, C4–C5 in 15%, C5–C6 in 10%, and C6–C7 in 5%. Trauma was the most common cause: 30% followed knife wounds, 20% followed gunshot injuries, and 10% followed blunt trauma. Eight patients had spontaneous fistulas, two associated with fibromuscular dysplasia. Three patients—all with large, long-standing fistulas—developed neurologic deficits coincident with the abrupt closure of the fistula, which resolved with reestablishment of fistula flow. Two of these patients were treated by staged closure; the other one by gradual closure. In all three cases the result was complete fistula closure without neurologic sequelae. The remaining spontaneous fistulas were all closed by balloon embolization with preservation of the vertebral artery and without deficits. The six patients with traumatic fistulas without transection were cured by balloon embolization, without deficits; in four there was also preservation of vertebral flow. The other six patients had traumatic fistulas with transection and were all cured by balloon embolization with preservation of flow in two. Four patients required bilateral approaches to the fistula to achieve complete fistula closure. The only complication was a mild residual Wallenberg syndrome after occlusion of the posterior inferior cerebellar artery in the treatment of a transection located at C1.

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      <h1 class="highwire-cite-title" id="page-title">Treatment of Vertebral Arteriovenous Fistulas</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Van V. Halbach</span>, <span class="highwire-citation-author" data-delta="1">Randall T. Higashida</span> and <span class="highwire-citation-author" data-delta="2">Grant B. Hieshima</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">November 1987,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">8 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1121-1128; </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-13513--6681475313" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Van V. Halbach </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>Departments of Radiology and Neurological Surgery, University of California, San Francisco Medical Center, 505 Parnassus Ave., San Francisco, CA 94143. Address reprint requests to V. V. Halbach, Neuroradiology, C-309</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Van%2BV.%2BHalbach%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Halbach%20VV&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AVan%2BV.%2BHalbach%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Randall T. Higashida </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>Departments of Radiology and Neurological Surgery, University of California, San Francisco Medical Center, 505 Parnassus Ave., San Francisco, CA 94143. Address reprint requests to V. V. Halbach, Neuroradiology, C-309</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Randall%2BT.%2BHigashida%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Higashida%20RT&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ARandall%2BT.%2BHigashida%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Grant B. Hieshima </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>Departments of Radiology and Neurological Surgery, University of California, San Francisco Medical Center, 505 Parnassus Ave., San Francisco, CA 94143. Address reprint requests to V. V. Halbach, Neuroradiology, C-309</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Grant%2BB.%2BHieshima%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hieshima%20GB&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AGrant%2BB.%2BHieshima%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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<p id="p-1">Twenty patients with vertebral arteriovenous fistulas (eight spontaneous, six traumatic without vertebral artery transection, and six traumatic with vertebral artery transection) were treated by transvascular embolization techniques, resulting in complete fistula closure in all patients. The fistulas were located at C1–C2 in 45%, C2–C3 in 25%, C4–C5 in 15%, C5–C6 in 10%, and C6–C7 in 5%. Trauma was the most common cause: 30% followed knife wounds, 20% followed gunshot injuries, and 10% followed blunt trauma. Eight patients had spontaneous fistulas, two associated with fibromuscular dysplasia. Three patients—all with large, long-standing fistulas—developed neurologic deficits coincident with the abrupt closure of the fistula, which resolved with reestablishment of fistula flow. Two of these patients were treated by staged closure; the other one by gradual closure. In all three cases the result was complete fistula closure without neurologic sequelae. The remaining spontaneous fistulas were all closed by balloon embolization with preservation of the vertebral artery and without deficits. The six patients with traumatic fistulas without transection were cured by balloon embolization, without deficits; in four there was also preservation of vertebral flow. The other six patients had traumatic fistulas with transection and were all cured by balloon embolization with preservation of flow in two. Four patients required bilateral approaches to the fistula to achieve complete fistula closure. The only complication was a mild residual Wallenberg syndrome after occlusion of the posterior inferior cerebellar artery in the treatment of a transection located at C1.</p>
<p id="p-2">In our opinion, transvascular techniques are the treatment of choice for vertebral arteriovenous fistulas.</p>
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 8</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 6 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Nov 1987 </div></div>
      
      
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      <div class="highwire-cite-title">Treatment of Vertebral Arteriovenous Fistulas</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">Van V.</span> <span class="nlm-surname">Halbach</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Randall T.</span> <span class="nlm-surname">Higashida</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Grant B.</span> <span class="nlm-surname">Hieshima</span></span></span></div>
  
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