Abstract：
To report a case of vertebral arteriovenous fistula (VAVF) caused by iatrogenic trauma of central venous catheterization (CVC) involving brachiocephalic vein (BCV).
A 79-year-old female was referred for assessment of a vertebral artery (VA) aneurysm at the V1 segment. The patient had no signs other than a vascular murmur on the right neck and was diagnosed 20 years after undergoing CVC. Right vertebral angiography revealed a high-flow shunt from the V1 segment of the right VA and draining into the right BCV. The fistula had a single communication between a pseudoaneurysm and large varix. We diagnosed the patient with CVCinduced VAVF (CIVAVF) involving BCV and obliterated the shunt by selective transarterial and transvenous embolization of the pseudoaneurysm under flow control using a balloon catheter with no complications.
This case highlights the point that CIVAVF involving BCV is rare but possible. In addition, there is a possibility that CIVAVF involving BCV does not demonstrate the findings of arterial steal or retrograde venous drainage and is undiagnosed for a long term due to lack of neurological manifestation and other subjective symptoms. We also showed that endovascular treatment can be feasible and useful for CIVAVF involving BCV.
A 79-year-old female was referred for assessment of a vertebral artery (VA) aneurysm at the V1 segment. The patient had no signs other than a vascular murmur on the right neck and was diagnosed 20 years after undergoing CVC. Right vertebral angiography revealed a high-flow shunt from the V1 segment of the right VA and draining into the right BCV. The fistula had a single communication between a pseudoaneurysm and large varix. We diagnosed the patient with CVCinduced VAVF (CIVAVF) involving BCV and obliterated the shunt by selective transarterial and transvenous embolization of the pseudoaneurysm under flow control using a balloon catheter with no complications.
This case highlights the point that CIVAVF involving BCV is rare but possible. In addition, there is a possibility that CIVAVF involving BCV does not demonstrate the findings of arterial steal or retrograde venous drainage and is undiagnosed for a long term due to lack of neurological manifestation and other subjective symptoms. We also showed that endovascular treatment can be feasible and useful for CIVAVF involving BCV.
摘要：
■报告一例涉及头臂静脉（BCV）的中心静脉导管（CVC）医源性损伤引起的椎动静脉瘘（VAVF）。
■一名79岁的女性被转诊以评估V1段的椎动脉（VA）动脉瘤。患者除了右颈部有血管杂音外没有其他症状，在接受CVC20年后被诊断出。右椎骨血管造影显示，右VA的V1段有高流量分流，并排入右BCV。瘘管在假性动脉瘤和大静脉曲张之间有单一的连通。我们诊断出患有CVC诱导的VAVF（CIVAVF）的患者涉及BCV，并通过使用球囊导管在流量控制下选择性经动脉和经静脉栓塞治疗假性动脉瘤，消除了分流。
■此案例强调了涉及BCV的CIVAVF很少见但有可能。此外,涉及BCV的CIVAVF有可能未发现动脉盗血或逆行静脉引流,并且由于缺乏神经系统表现和其他主观症状而长期未被诊断.我们还表明，血管内治疗对于涉及BCV的CIVAVF是可行且有用的。
■一名79岁的女性被转诊以评估V1段的椎动脉（VA）动脉瘤。患者除了右颈部有血管杂音外没有其他症状，在接受CVC20年后被诊断出。右椎骨血管造影显示，右VA的V1段有高流量分流，并排入右BCV。瘘管在假性动脉瘤和大静脉曲张之间有单一的连通。我们诊断出患有CVC诱导的VAVF（CIVAVF）的患者涉及BCV，并通过使用球囊导管在流量控制下选择性经动脉和经静脉栓塞治疗假性动脉瘤，消除了分流。
■此案例强调了涉及BCV的CIVAVF很少见但有可能。此外,涉及BCV的CIVAVF有可能未发现动脉盗血或逆行静脉引流,并且由于缺乏神经系统表现和其他主观症状而长期未被诊断.我们还表明，血管内治疗对于涉及BCV的CIVAVF是可行且有用的。
