Covered stent placement in a traumatically injured vertebral artery

Stent-Graft Treatment of a Giant Asymptomatic Extracranial Vertebral Artery Aneurysm: Case Report and Literature Review

With the widespread appliance of endovascular techniques, a plethora of options is available in the treatment of extracranial vertebral artery aneurysms. If the vertebral artery can be sacrificed, embolization with coiling, liquid injection, or parent artery exclusion can be done. We hereby present a case of a 74-year-old male patient presenting with an asymptomatic atherosclerotic giant extracranial vertebral artery aneurysm in the V1 segment of the vertebral artery, successfully treated with balloon expandable stent-graft deployment. No neurologic symptoms occurred, and the stent-graft was patent with no signs of endoleak at 24 months follow-up with computed tomography angiography.

Endovascular and surgical approaches of iatrogenic vertebrovertebral arteriovenous fistula

Vertebrovertebral arteriovenous fistula is an uncommon vascular disease with no clear management guidelines. It is most commonly caused by iatrogenic injury. We have presented the details of two iatrogenic cases and a review to discuss strategies for endovascular and surgical approaches. From the digital subtraction angiography findings, the vertebrovertebral arteriovenous fistulas were occluded by endovascular coil positioning (patient 1) and surgical ligation of the fistulas (patient 2). Although endovascular approaches are increasing in popularity and considered well-tolerated treatments, open surgical treatment is still reserved for the most complex cases and those not feasible for endovascular treatment.

Iatrogenic left vertebral artery pseudoaneurysm treated with a covered stent

Vertebral artery pseudoaneurysm usually occurs after major trauma, but it can arise spontaneously after trivial injury. Clinical manifestations are often related to alterations in the posterior brain circulation. CT and angiography are usually the diagnostic methods of choice. We present a case of a pseudoaneurysm of the left vertebral artery caused by a lesion during a cervical spine surgery and treated with endovascular approach with a covered stent.

Vertebral Arteriovenous Fistula: A Review Article

OBJECTIVE

Vertebrovertebral fistulas (VVFs) are uncommon lesions that can arise spontaneously or secondarily to iatrogenic or mechanical trauma. We performed a systematic review of the literature to obtain information regarding demographics, clinical presentation, treatment modalities, outcome, and complications associated with treatment.

METHODS

A literature search was performed by a reference librarian and after screening, 128 case reports and 16 case series were left for inclusion in the review. All possible data were abstracted by 3 authors, results were tabulated, and descriptive statistics (mean, range, and proportions) were reported. No formal statistical analysis was performed as part of this study.

RESULTS

A total of 280 patients were analyzed. VVFs can be categorized in 3 subgroups (iatrogenic, spontaneous, and traumatic), based on the mechanism of formation, and these different causes share different underlying demographics that bear important treatment considerations. Traumatic VVFs are more commonly seen in young men; the spontaneous form is more commonly seen in young women. Iatrogenic VVFs are more commonly seen in elderly people. Spontaneous VVFs are most commonly located between C1 and C2. Most iatrogenic (n = 39; 57%), spontaneous (n = 106; 82%), and traumatic (n = 53; 73%) VVFs were treated with deconstructive (defined as occlusion of fistula and feeding vessels) endovascular therapy. Overall treatment-related permanent morbidity was 3.3% (9/270) and mortality was 1.5% (4/270).

CONCLUSIONS

VVFs are uncommon lesions, and treatment is often indicated, even in patients without retrograde venous drainage. When treatment is undertaken, the cause of presentation and associated patient demographics should be considered when planning the treatment strategy.

Endovascular implantation of covered stents in the extracranial carotid and vertebral arteries: Case series and review of the literature

Background:

Covered stents are used endovascularly to seal arterial wall defects while preserving vessel patency. This report describes our experience with the use of covered stents to treat cervical pathology, and a review of the literature in regards to this topic is presented.

Case Description:

Two patients presenting with the carotid blowout syndrome and one patient with a vertebrojugular fistula were treated with covered stents. This allowed for preservation of the vessel and was a treatment alternative to cerebral bypass.

Conclusion:

Covered stents provide a viable means of preserving the cervical vessels in selected patients; however, long-term follow-up is necessary to determine stent patency and permanency of hemostasis.

Delayed presentation of a vertebral arterio-venous fistula secondary to penetrating cervical trauma: endovascular management using coil embolisation - a case report

Vertebro-vertebral arteriovenous fistulae occur infrequently. We report on such a case with delayed presentation following penetrating neck injury. This was successfully treated via coil embolisation. A 40-year-old woman presented with a subjective tinnitus that was abolished by turning her head to the right. She had sustained penetrating neck trauma 6 months earlier. Doppler Ultrasound and magnetic resonance angiogram confirmed the presence of a vertebral arterio-venous fistula. Using a trans-femoral arterial approach, the left vertebral artery was embolised by deployment of multiple coils. The patient had no return of symptoms at 3 months follow up. Radiological diagnosis and endovascular management of this condition is discussed.

Treatment of an iatrogenic vertebral artery laceration with the Symbiot self expandable covered stent

Vertebral artery laceration is difficult to treat surgically. Endovascular treatment with balloon expandable covered stents often fails due to their rigidity and poor navigability. We present a case of iatrogenic vertebral artery laceration where endovascular treatment with a balloon expandable covered stent failed. Eventually a self expandable symbiot covered stent was deployed over the laceration, securing hemostasis and preserving the vessel patency. The newer self expandable covered stents seem promising in the treatment of vertebral artery injury.

Endovascular Treatment of a Vertebral Artery Pseudoaneurysm in a Drug User

A 26-year-old drug abuser who presented with sepsis was found to have a pseudoaneurysm in the left vertebral artery. This aneurysm was presumed to be post-traumatic, since the patient reported multiple attempts to inject drugs in the left jugular vein 15 days prior to admission. The pseudoaneurysm was treated effectively with stent-graft placement.