Traumatic Arteriovenous Fistula

 DSA demonstration of AVF nidus with enlarged draining veins

image Unlike spontaneous DAVF (sDAVF), often no cord enlargement/hyperintensity from congestive myelopathy

• Angiographic protocol for evaluation of suspected cervical tDAVF includes selective injections of both external carotid + vertebral arteries, thyrocervical trunks, and paired segmental arteries
image Angiographic appearance is similar to sDAVF, but nidus may be extraforaminal/paravertebral instead of along nerve root


• Any segment of spine, most frequently cervical

• Usually caused by direct penetrating wounds

• May also occur with blunt trauma and vertebral fracture

Clinical Issues

• Symptoms may relate to
image Venous hypertensive myelopathy

image Compression by enlarged draining veins

image Steal phenomenon

• Endovascular treatment with embolization or surgical ligation

(Left) Off-midline sagittal T1WI MR shows an enlarged ventral epidural venous plexus with a prominent flow void image in this patient with a C2 fracture.

(Right) Axial T2* GRE MR shows dilation of the epidural venous plexus with prominent flow voids image causing compression of the nerve root in the lateral recess of the cervical spine.

(Left) Anteroposterior DSA from the left vertebral artery shows high-flow arteriovenous communication near the V2/V3 junction of the right vertebral artery image, with reversed flow in the distal right vertebral artery supplying dilated epidural plexus image and dilated deep cervical veins.

(Right) Coronal CT myelography of the lumbar spine shows dilated, tortuous veins in the caudal thecal sac image due to a post-traumatic (iatrogenic) arteriovenous fistula.



• Arteriovenous fistula (AVF)

• Traumatic dural AV fistula (tDAVF)


• Vertebrovertebral arteriovenous fistula


• Trauma-induced arteriovenous fistula


General Features

• Best diagnostic clue
image DSA demonstration of AVF nidus with enlarged draining veins

• Location
image Dural or extradural nidus

image Any segment of spine, most frequently cervical

• Size
image Small nidus

image May have extensive draining venous engorgement

Oct 5, 2016 | Posted by in NEUROLOGICAL IMAGING | Comments Off on Traumatic Arteriovenous Fistula

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