Spontaneous vertebrovertebral arteriovenous fistulae - Clinical features, angioarchitecture and management of twelve patients

Spontaneous vertebrovertebral arteriovenous fistula (SVVAVF) is a rare condition which often presents as a bruit. We reviewed the clinical and imaging records of 12 patients with 13 SVVAVF fistulae who were managed at our institution over the last 14 years. Two patients had predisposing conditions, neurofibromatosis in one and Ehlers-Danlos syndrome in the other. Nine of the patients presented with a bruit; one patient presented with a myelopathy and one with congestive cardiac failure, Six of the 13 fistulae were at C1 and five of these six were children. In seven of the fistulae there was retrograde flow in the distal vertebral artery. Eight patients underwent endovascular treatment. Six required both contralateral and ipsilateral vertebral artery approaches. Coils (two patients), balloons (three patients), or a combination of agents including liquid adhesives (three patients) were used. Preservation of the vertebral artery was possible in three of the eight patients, Angiographic obliteration was obtained in all eight patients, There were no significant procedure-related complications. Embolisation is the primary treatment of SVVAVF and can be performed successfully with low morbidity. Preservation of the vertebral artery, although desired, is often not possible.