2017 Volume 39 Issue 2 Pages 145-149
A 25-year-old woman with a right neck swelling visited her local hospital, where paravertebral arteriovenous fistula (PAVF) was diagnosed. The PAVF was fed mainly by the ascending cervical artery and also by the subcutaneous cervical, external cervical, and vertebral arteries, and it drained via multiple fistulas and a varix into the paravertebral venous plexus. Ligation of the main feeding artery and transarterial embolization were performed, but the PAVF recurred, so the patient was referred to our hospital, where angiography revealed multiple high-flow feeding arteries, fistulas, and draining veins. We adopted a bidirectional treatment strategy, combining transarterial and transvenous catheterization and coil embolization. The fistulas were obliterated, and 1-year follow-up angiography showed no signs of recurrence. PAVF is a rare condition involving spinal vascular malformations and for which there is no established treatment strategy. Simultaneous transarterial and transvenous embolization should be considered for PAVF with a complex angioarchitecture.
