Endovascular Treatment of Vertebral-Venous Fistula with Flow-Diverting Stent

BACKGROUND: Vertebral-venous fistulas (VVFs) are a rare vascular condition and are commonly associated with trauma but may also be idiopathic, spontaneous, or congenital. A current literature review reveals there is no level 1 evidence or established guidelines on optimal treatment for VVF. Diagnosis is often confirmed by catheter cerebral angiogram. Treatment goals are complete occlusion of the fistula, which can be achieved by both endovascular closure and/or surgical ligation treatment. Telescopic Pipeline flow-diversion stents are a common treatment modality for aneurysms and have also been described to successfully treat different types of cranial arteriovenous fistulas including carotid-cavernous fistulas. There is, however, no English literature available regarding its use in the management of VVFs, which are rare entities. CASE DESCRIPTION: The authors present a case of VVF, which is the first reported case to their knowledge whereby a Pipeline flow-diverting stent has been used to successfully treat a VVF while preserving the parent vertebral artery. The authors describe both the advantages and limitations of this approach. CONCLUSIONS: This case report highlights the potential of flow-diversion stents in the treatment of VVF. This technique was shown to be a safe and effective method of treatment for VVF. Important limitations, however, need to be considered before this form of treatment for VVF, including the need for multiple devices, extended duration of treatment, and associated increased costs involved.