Spontaneous Arterio-venous Fistula of the Vertebral Artery

“The vertebral artery cannot be ligated on account of its great depth, nor compressed because of the osseous canal which protects it; it can still less be cauterised. The wounds of this vessel are beyond the resources of art.” These comments were made by Sanson of the Faculty of Paris in 1836. Seventeen years later Maisonneuve and Favrot successfully ligated the vertebral artery, in its first part, for damage due to a gunshot wound. In 1864 Andrew W. Smythe successfully ligated the vertebral artery in the first premeditated operation ever performed on this vessel. The procedure was tried as a remedy for a subclavian aneurysm. Rudolph Matas published his monograph in 1893. He reported a case of a vertebral artery fistula due to injury: and added 19 more cases collected from the literature. Elkins and Harris added ten more cases of vertebral arterio-venous fistula in 1945. The lesions were in the cervical course of the vessel. The diagnosis was made with certainty in five cases in this series, being only suspected in the other five.