Current Insights and Management Strategies for Lower Cervical Arteriovenous Fistulas: A Comprehensive Review

Area of Science:

• Neurology
• Vascular Surgery
• Radiology

Background:

• Lower cervical arteriovenous fistulas (AVFs) are uncommon and complex vascular malformations.
• They present significant clinical challenges due to their anatomical location and diverse clinical manifestations.
• Existing research predominantly focuses on upper cervical AVFs, leaving lower cervical AVFs understudied.

Purpose of the Study:

• To review clinical presentations, management strategies, and outcomes of patients with lower cervical AVFs.
• To enhance the understanding of these rare vascular malformations.
• To guide improved treatment approaches for lower cervical AVFs.

Main Methods:

• Retrospective analysis of two local cases of lower cervical AVFs.
• Systematic literature review following PRISMA guidelines across Ovid MEDLINE, PubMed, and Cochrane.
• Inclusion of 44 patients with lower cervical AVFs from literature and local cases.

Main Results:

• The study analyzed 44 patients (50% female, mean age 48.68 years) with lower cervical AVFs.
• Clinical presentations included hemorrhage (27.3%), myelopathy (18.2%), and asymptomatic cases (18.2%).
• Treatment involved endovascular embolization (40.9%), surgery (25%), and combined methods (18.2%), with 54.5% achieving good recovery.

Conclusions:

• Lower cervical AVFs exhibit varied presentations and complex anatomy, posing diagnostic and therapeutic challenges.
• Timely diagnosis and individualized management, including endovascular and surgical options, are crucial for optimal patient outcomes.
• Further research is warranted to elucidate the natural history of asymptomatic AVFs and refine treatment protocols.