Objective:

To describe a case of spinal cord compression as complication of pelvic arteriovenous fistula

Background:

Arteriovenous fistula (AVF) is an abnormal communication between an artery and a vein. It is frequently a consequence of trauma. Most spinal AVFs are from dural AVFs. Extra-spinal AVFs are rare causes for vascular spinal myelopathy.  

Design/Methods:

NA

Results:

59 year old male with history of gunshot wound to the abdomen with residual bullet fragments and left foot numbness initially presented with 4 months of gradually progressive low back pain with radiating tightness and achiness down both lower extremities. Initial exam with positive straight leg test, mild left hip flexion weakness, mild hypo-reflexia at patellars. X-ray with mild scoliosis. Treated with physical therapy and baclofen. At three-month follow-up, clinically worsened with new left foot drop and markedly worsened hip flexion. Patient required a cane for ambulation. CT of the lumbar spine showed enlargement of internal iliac vasculature with substantial epidural venous engorgement resulting in narrowing of thecal sac at L3-5 levels. Spinal angiogram confirmed left pelvic region arteriovenous fistula with primary arterial supply from the left L5 segmental artery and left superficial circumflex iliac artery, occlusion of the left internal iliac artery origin, enlargement of pelvic vein with variceal features, and reflux into engorged vessels within Bason’s plexus. Patient was treated with extensive coil and onyx embolization via left superficial circumflex iliac arterial access. Patient had improved left hip flexor strength but residual left foot drop 3 years after intervention.  

Conclusions:

Extraspinal vascular malformations represent a rare cause of vascular spinal myelopathy. Endovascular approach can lead to beneficial outcomes.