• Isao Ono, Tetsu Satow, Yoshiro Ito, Eika Hamano, Hirofumi Matsubara, Hiroharu Kataoka, and Jun C Takahashi.
• Department of Neurosurgery, National Cerebral and Cardiovascular Center, Fujishirodai Suita, Osaka, Japan.
• World Neurosurg. 2019 Aug 1; 128: 98-101.

BackgroundA case of high-flow cervical vertebro-vertebral arteriovenous fistula (VVAVF), which was occluded with detachable coils by the transarterial/transvenous double-catheter technique and balloon anchoring technique, is reported.Case DescriptionA 32-year-old male who had a history of dilated cardiomyopathy, heart failure, and arrhythmia under anticoagulation presented with a neck bruit after a right internal jugular vein puncture. A high-flow VVAVF between the right vertebral artery (VA) and vertebral vein (VV) was revealed by ultrasonography and angiography. To extirpate the shunt while preserving the right VA without using a stent to avoid antiplatelet therapy, the double-catheter technique was used to occlude the vein and shunt tightly, 1 catheter from the venous side and the other from the VA to the VV through the shunt. Finally, stabilization of the coil cage in the dilating VV was secured by placing a balloon distally as an anchor and successfully occluding the shunt with small amounts of coils only on the venous side. The shunt and cervical bruit disappeared immediately after the treatment, and no recurrence was observed.ConclusionsThe double-catheter technique and balloon anchoring technique used in this case seem effective for transvenous embolization of VVAVF when preservation of the VA is desired.Copyright © 2019 Elsevier Inc. All rights reserved.

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