Case report: Traumatic vertebral artery injury complicated with arteriovenous fistula and pseudoaneurysm

Abstract

We describe a 75-year-old man with rare traumatic vertebral artery injury (TVAI) complicated with a vertebral giant pseudoaneurysm and an arteriovenous fistula. He had been involved in a traffic accident and arrived at our hospital by ambulance in a comatose, tetraplegic state. Initial CT findings revealed cervical subluxation between C4 and C5, and CT angiography (CTA) showed aneurysmal dilation arising from an obliterated left VA at the C4/5 level. Repeat CTA on the following day showed that the aneurysm had rapidly expanded to 3 cm. Emergency angiography revealed complete occlusion of the left VA at the C4/5 level with a giant pseudoaneurysm and a vertebral artery arteriovenous fistula (VA-AVF) with drainage to the external vertebral plexus. The contralateral right VA was also occluded. Endovascular internal trapping of the left VA, including the giant pseudoaneurysm, was followed by cervical spine fixation. The patient was then transferred to a rehabilitation center. Serial CTA and coil embolization of a giant pseudoaneurysm and an AVF were safely performed, and effectively prevented fatal bleeding in this patient with severely traumatic cervical injury.