Acute traumatic vertebral arteriovenous fistula: balloon occlusion with the use of a contralateral approach.

A traumatic fistula of the left vertebral artery to vertebral and epidural veins with an expanding suboccipital false aneurysm was trapped by endovascular occlusion with detachable balloons. The lesion was not amenable to treatment using the left vertebral artery alone for access. Distal trapping was accomplished by catheterizing the (contralateral) right vertebral artery and placing the balloon retrograde into the distal segment of the left vertebral artery. This maneuver extends the range of vertebral artery lesions for which detachable balloons, either alone or as an adjunct to operation, can be used.