Vertebral Arteriovenous Fistula: A Review Article

Abstract Object Vertebro-vertebral fistulas (VVFs) are uncommon lesions that can arise spontaneously or secondarily to iatrogenic or mechanical trauma. We performed a systematic review of the literature to obtain information regarding demographics, clinical presentation, treatment modalities, outcome, and complications associated with treatment. Methods A literature search was performed by a reference librarian and after screening, 128 case reports and 16 case series were left for inclusion in the review. All possible data was abstracted by three authors, results were tabulated and descriptive statistics (mean, range; and proportions) were reported. No formal statistical analysis was performed as part of this study. Results 280 patients were analyzed. VVFs can be categorized in three subgroups: iatrogenic, spontaneous and traumatic, based on the mechanism of formation, and these different etiologies share different underlying demographics that bear important treatment considerations. Traumatic VVFs are more commonly seen in young men; the spontaneous form is more commonly seen in young women. Iatrogenic VVFs are more commonly seen in elderly people. Spontaneous VVFs are most commonly located between C1 and C2. Most iatrogenic (n=39; 57%), spontaneous (n=106; 82%), and traumatic (n=53; 73%) VVFs were treated with deconstructive (defined as occlusion of fistula and feeding vessels) endovascular therapy. Overall treatment-related permanent morbidity was 3.3% (9/270) and mortality was 1.5% (4/270). Conclusions Vertebro-vertebral fistulas are uncommon lesions, and treatment is often indicated, even in patients without retrograde venous drainage. When undertaken, the etiology of presentation and associated patient demographics should be considered when planning the treatment strategy.