Onyx Embolization of High-Flow Spontaneous Cervical Vertebral Arteriovenous Fistula

Abstract

Background and Importance: High-flow spontaneous vertebral arteriovenous shunts in patients with fibromuscular disease (FMD) are rare. Onyx embolizaton of the recipient veins with shunt disconnection and preservation of the affected vertebral artery in a patient with FMD has not been reported. Clinical Presentation: A 59-year-old female presented with progressive dizziness, pre-syncopal episodes, and tinnitus. Catheter-based angiography identified features of fibromuscular dysplasia and a high-flow right cervical vertebral artery arteriovenous shunt. Onyx embolization of the principle draining veins was performed with initial detachable coil placement. Complete disconnection of the shunt was achieved without sacrifice of the parent vertebral artery. Conclusion: Spontaneous high-flow vertebral arteriovenous shunts can be successfully occluded with Onyx/detachable coil embolization of the principle recipient veins.