Simultaneous findings of shunt obliteration and arterial flow restoration during balloon-assisted technique in the management of idiopathic vertebral arteriovenous fistula.

The etiology of vertebral arteriovenous fistulas (VAVFs) is diverse, and when selecting an optimal therapeutic strategy, it is important to evaluate the feasibility of preserving the vertebral artery (VA). A 75-year-old woman presented with pulsatile tinnitus, and imaging revealed a high-flow vertebral arteriovenous fistula (VAVF) with a single shunt point at the V2 segment; the distal ipsilateral VA was not visualized, suggesting occlusion or a steal phenomenon. Stepwise balloon adjustment near the shunt site eliminated shunt flow and restored distal VA flow, confirming steal and enabling a successful vessel-preserving treatment. This case demonstrates that controlled modulation of flow near the shunt site using a balloon catheter can effectively predict the potential for restoration of VA flow, and suggests the clinical utility of this technique in planning a strategy that achieves shunt obliteration while preserving the vertebral artery.