High-energy blunt traumatic vertebro-vertebral arteriovenous fistula with retropharyngeal hematoma: a case report.

BACKGROUND: We report a case of high-energy blunt traumatic vertebro-vertebral arteriovenous fistula with retropharyngeal hematoma following C2 vertebral fracture after a motor vehicle crash. Although there is currently no established guideline to treat blunt traumatic vertebro-vertebral arteriovenous fistula, effective transarterial embolization to sacrifice the parent artery succeeded in complete obliteration of the vertebro-vertebral arteriovenous fistula with no ischemic complications. CASE PRESENTATION: A 74-year-old Japanese woman injured in a motor vehicle crash was transferred to our hospital for evaluation of neck pain and headache. She was hemodynamically stable on arrival. Computed tomography revealed a low-volume subarachnoid hemorrhage, cervical spinal fracture (C2), rib fracture, and thoracic spinal compression fracture. Contrast-enhanced computed tomography showed suspected dissection of her right vertebral artery at the C2 level. On day 2, extravasation from her right vertebral artery at the C2 level was suspected on magnetic resonance angiography, and a thick retropharyngeal hematoma was revealed on a T2-weighted magnetic resonance image. The angiographic study indicated a diagnosis of high-flow vertebro-vertebral arteriovenous fistula at the C2 level. Transarterial embolization with coils was performed to sacrifice the parent artery, and n-butyl-2-cyanoacrylate injection significantly reduced flow through the fistula, which succeeded in completely obliterating the fistula on day 30. CONCLUSIONS: Vertebro-vertebral arteriovenous fistula caused by high-energy blunt trauma is extremely rare, but an upper cervical spine injury may trigger it, and retropharyngeal hematoma may sometimes also occur. Transarterial coil embolization of the parent artery to completely obliterate the fistula may be considered a reliable treatment in the acute stage.