Vertebral arteriovenous fistula associated with an anomalous arterial vessel

The widespread use of angiography in patients sustaining vascular trauma has demonstrated an increased incidence in vertebral artery injuries. With the improvement in peripheral vascular techniques and the utilization of extended exposure of the vertebral artery, aggressive therapy now is generally advocated. While new concepts continue to evolve, it becomes important to report anatomical variants that are not commonly recognized. An anomalous vessel originating from the proximal subclavian artery is reported. Initial ligation of a seemingly normal vertebral artery failed to control the fistula which was fed by the anomalous vessel. The importance of complete arteriographic studies is stressed. In particular, it is important to visualize the vascular anatomy both proximally and distally to the injury in order that anomalous vessels are recognized. Arteriography will improve diagnosis, help plan operative or nonoperative therapy, and decrease the incidence of missed injuries and complications.