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Endovascular stent-graft treatment of a traumatic vertebral artery pseudoaneurysm and vertebrojugular fistula.

Sancak T, Bilgic S, Ustuner E - Korean J Radiol (2008)

Bottom Line: An endovascular intervention is a feasible alternative to the technically challenging conventional surgery for the treatment of traumatic vertebral arterial lesions.This report describes a rare case involving a 22-year-old patient with a traumatic vertebral arterial pseudoaneurysm and multiple arteriovenous fistulas which were successfully sealed using the endovascular stent-graft technique.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Ankara University Faculty of Medicine, Ibni Sina Hospital, Hasircilar Street, Sihhiye 06100 Ankara, Turkey. sancaki@yahoo.com

ABSTRACT
An endovascular intervention is a feasible alternative to the technically challenging conventional surgery for the treatment of traumatic vertebral arterial lesions. This report describes a rare case involving a 22-year-old patient with a traumatic vertebral arterial pseudoaneurysm and multiple arteriovenous fistulas which were successfully sealed using the endovascular stent-graft technique.

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Related in: MedlinePlus

Endovascular stent-graft treatment in 22-year-old man.A. Left vertebral arterial injection revealing early filling of pseudoaneurysm (arrow) and opacification of vertebrojugular fistulas (star).B. Late phase of left vertebral angiography. Pseudoaneurysm (arrow) and arteriovenous fistulas (double arrows) are more visible compared to left vertebral arterial injection.C. Complete sealing of pseudoaneurysm and arteriovenous fistulas after deployment of stent greft into left vertebral artery.D. Stenosis of left vertebral artery was noted on follow-up angiogram (arrow). Tip of catheter was in left subclavian artery (arrowhead).E. After treatment of stenosis by angioplasty, complete recanalisation of lumen was noted on angiogram.
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Figure 1: Endovascular stent-graft treatment in 22-year-old man.A. Left vertebral arterial injection revealing early filling of pseudoaneurysm (arrow) and opacification of vertebrojugular fistulas (star).B. Late phase of left vertebral angiography. Pseudoaneurysm (arrow) and arteriovenous fistulas (double arrows) are more visible compared to left vertebral arterial injection.C. Complete sealing of pseudoaneurysm and arteriovenous fistulas after deployment of stent greft into left vertebral artery.D. Stenosis of left vertebral artery was noted on follow-up angiogram (arrow). Tip of catheter was in left subclavian artery (arrowhead).E. After treatment of stenosis by angioplasty, complete recanalisation of lumen was noted on angiogram.

Mentions: The patient was thoroughly informed of the lesion as well as the outcomes and possible complications of the various available treatment methods. After informed consent was obtained for the stent-graft procedure and other endovascular occlusive treatments, a digital subtraction angiography (DSA) (Multistar Plus/T.O.P., Siemens AG, Forchheim, Germany) was performed using Five French catheters (Weinberg, Digiflex, Boston Scientific Corporation, Watertown, MA), which were introduced into the vertebral arteries via the femoral approach. The selective views of the vertebral arteries were taken by injecting 6 ml of nonionic contrast agent (Iomeron 400 mgI/ml, Bracco SpA, Milan, Italy). The angiography confirmed a 3 cm pseudoaneurysm at the cervical segment of the vertebral artery in addition to multiple arterivenous fistulas (Figs. 1A, B). The right vertebral artery was patent with adequate basilar artery flow in addition to the cross-filling of the left vertebral artery from the right vertebral artery with retrograde opacification of the fistulas. The markings on the catheter served for sizing the diameter of the vertebral artery as well as the careful measure of the pseudoaneurysm. In addition, special care was taken to identify the exact origin and level of the arteriovenous fistulas via multiple injections and meticulous analysis of the angiographic sequences.


Endovascular stent-graft treatment of a traumatic vertebral artery pseudoaneurysm and vertebrojugular fistula.

Sancak T, Bilgic S, Ustuner E - Korean J Radiol (2008)

Endovascular stent-graft treatment in 22-year-old man.A. Left vertebral arterial injection revealing early filling of pseudoaneurysm (arrow) and opacification of vertebrojugular fistulas (star).B. Late phase of left vertebral angiography. Pseudoaneurysm (arrow) and arteriovenous fistulas (double arrows) are more visible compared to left vertebral arterial injection.C. Complete sealing of pseudoaneurysm and arteriovenous fistulas after deployment of stent greft into left vertebral artery.D. Stenosis of left vertebral artery was noted on follow-up angiogram (arrow). Tip of catheter was in left subclavian artery (arrowhead).E. After treatment of stenosis by angioplasty, complete recanalisation of lumen was noted on angiogram.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627192&req=5

Figure 1: Endovascular stent-graft treatment in 22-year-old man.A. Left vertebral arterial injection revealing early filling of pseudoaneurysm (arrow) and opacification of vertebrojugular fistulas (star).B. Late phase of left vertebral angiography. Pseudoaneurysm (arrow) and arteriovenous fistulas (double arrows) are more visible compared to left vertebral arterial injection.C. Complete sealing of pseudoaneurysm and arteriovenous fistulas after deployment of stent greft into left vertebral artery.D. Stenosis of left vertebral artery was noted on follow-up angiogram (arrow). Tip of catheter was in left subclavian artery (arrowhead).E. After treatment of stenosis by angioplasty, complete recanalisation of lumen was noted on angiogram.
Mentions: The patient was thoroughly informed of the lesion as well as the outcomes and possible complications of the various available treatment methods. After informed consent was obtained for the stent-graft procedure and other endovascular occlusive treatments, a digital subtraction angiography (DSA) (Multistar Plus/T.O.P., Siemens AG, Forchheim, Germany) was performed using Five French catheters (Weinberg, Digiflex, Boston Scientific Corporation, Watertown, MA), which were introduced into the vertebral arteries via the femoral approach. The selective views of the vertebral arteries were taken by injecting 6 ml of nonionic contrast agent (Iomeron 400 mgI/ml, Bracco SpA, Milan, Italy). The angiography confirmed a 3 cm pseudoaneurysm at the cervical segment of the vertebral artery in addition to multiple arterivenous fistulas (Figs. 1A, B). The right vertebral artery was patent with adequate basilar artery flow in addition to the cross-filling of the left vertebral artery from the right vertebral artery with retrograde opacification of the fistulas. The markings on the catheter served for sizing the diameter of the vertebral artery as well as the careful measure of the pseudoaneurysm. In addition, special care was taken to identify the exact origin and level of the arteriovenous fistulas via multiple injections and meticulous analysis of the angiographic sequences.

Bottom Line: An endovascular intervention is a feasible alternative to the technically challenging conventional surgery for the treatment of traumatic vertebral arterial lesions.This report describes a rare case involving a 22-year-old patient with a traumatic vertebral arterial pseudoaneurysm and multiple arteriovenous fistulas which were successfully sealed using the endovascular stent-graft technique.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Ankara University Faculty of Medicine, Ibni Sina Hospital, Hasircilar Street, Sihhiye 06100 Ankara, Turkey. sancaki@yahoo.com

ABSTRACT
An endovascular intervention is a feasible alternative to the technically challenging conventional surgery for the treatment of traumatic vertebral arterial lesions. This report describes a rare case involving a 22-year-old patient with a traumatic vertebral arterial pseudoaneurysm and multiple arteriovenous fistulas which were successfully sealed using the endovascular stent-graft technique.

Show MeSH
Related in: MedlinePlus