A Case of Vertebro-vertebral Arteriovenous Fistula Clinically Diagnosed as Segmental Arterial Mediolysis Complicated by Celiac Artery Aneurysm Suspected in a State of Impending Rupture

Abstract

Objective: Vertebro-vertebral arteriovenous fistula (VVAVF) is a rare disorder that often forms a high blood flow shunt. It is mostly due to trauma, but it is occasionally caused by systemic diseases. Segmental arterial mediolysis (SAM) is characterized by non-inflammatory/non-atherosclerotic segmental lysis of the arterial media and is often diagnosed due to intraperitoneal hemorrhage from a ruptured abdominal visceral artery.

Case Presentation: A 45-year-old male with right VVAVF presented with pulsating tinnitus and underwent coil embolization of the right vertebral artery around the fistula. Cerebral angiography disclosed multiple aneurysms in the head and neck region. Abdominal contrast-enhanced CT showed a dissecting aneurysm extending from the celiac artery to the splenic artery. Since impending rupture was suspected, the aneurysm was embolized later at the radiology department.

Conclusion: A case of VVAVF complicated by SAM is reported. If multiple arterial abnormalities are observed, systemic examination and appropriate intervention are important.