2017 年 11 巻 2 号 p. 81-87
Objective: Vertebral arteriovenous fistula is a rare entity caused primarily by trauma and is known to occur iatrogenically after penetrating trauma of the neck and surgery of the cervical spine. We present a case of iatrogenic vertebral arteriovenous fistula that was caused by erroneous jugular vein puncture and could be radically treated by target embolization after localizing the shunt points using high-resolution cone-beam computed tomography (HR-CBCT) with a review of the literature.
Case Presentation: A 76-year-old woman with a history of coronary artery disease treated with percutaneous intervention underwent scheduled cardiac catheterization by the right radial artery and right internal jugular vein approaches. Following several test punctures of the right cervical region, a 6 Fr sheath was placed in the right jugular vein, but she began to note tinnitus around this time. As vascular bruit was heard in the neck, the patient was referred to our hospital. By MRI and angiography, left vertebral arteriovenous fistula was diagnosed. Two shunt points could be identified by preoperative HR-CBCT. Trans-arterial target embolization was performed on the vein side across the shunt points, resulting in the disappearance of the shunt flow with tinnitus and vascular bruit.
Conclusion: A case of iatrogenic vertebral arteriovenous fistula that could be radically treated by trans-arterial target embolization was reported. HR-CBCT was useful for the localization of the shunt points.