Endovascular repair of subclavian artery complex pseudoaneurysm and arteriovenous fistula with coils and Onyx Nana Amiridze, MD, PhD, Yougi Trivedi,

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Endovascular repair of subclavian artery complex pseudoaneurysm and arteriovenous fistula with coils and Onyx Nana Amiridze, MD, PhD, Yougi Trivedi, MD, Kshitij Dalal, MD Journal of Vascular Surgery Volume 50, Issue 2, Pages 420-423 (August 2009) DOI: 10.1016/j.jvs.2009.03.043 Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 1 A, B, Magnetic resonance imaging (MRI) of the brain. Axial fluid attenuated inversion recovery (FLAIR) images demonstrate encephalomalacia resulting from old infarcts within bilateral paramedian parietal and occipital lobes and superior cerebellum. C, Magnetic resonance angiography (MRA). Time-of-flight technique demonstrates abnormal high signal within the left internal jugular vein (IJV), sigmoid and transverse sinuses (TS), and cervical epidural plexus venous (EPV) as a result of retrograde arterialized flow. A large aneurysm (AN) is present at the level of the left vertebral artery origin (LVA). Right vertebral artery (RVA) is normal. D, Computed tomography (CT) with contrast at the level of the clavicles demonstrates a large lobulated aneurysm anterior to the subclavian artery and prominent bilateral veins. Journal of Vascular Surgery 2009 50, 420-423DOI: (10.1016/j.jvs.2009.03.043) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 2 Three-dimension (3D) angiogram of the left subclavian artery (SA), oblique projection, demonstrates high-flow arteriovenous fistula just distal to the left vertebral artery (VA) origin, combined with a large lobulated pseudoaneurysm. Rapid filling of the remnant of the left brachiocephalic vein occluded distally and draining into hemiazygous vein (HAV) through hypertrophied superior costal vein, epidural veins (EPIV), and retrograde flow into internal jugular vein (IJ) and subclavian vein. Journal of Vascular Surgery 2009 50, 420-423DOI: (10.1016/j.jvs.2009.03.043) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 3 A, B, Left subclavian artery angiogram, anterior-posterior and lateral projections. C, Balloon-assisted embolization with coils and Onyx. D, Postembolization angiogram demonstrates occlusion of the fistula with preservation of left vertebral and subclavian arteries. Journal of Vascular Surgery 2009 50, 420-423DOI: (10.1016/j.jvs.2009.03.043) Copyright © 2009 Society for Vascular Surgery Terms and Conditions