Huai-xue Mi ¹ Chun-Mei Guo ² Shan-Liang Chen ¹ Jun Zhang ³ Zhi Gao ¹ Li Hongxin ^1* Ju Han ^3*

• ¹ Department of Cardiovascular Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
• ² Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong Province, China
• ³ Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China

The vertebrojugular arteriovenous fistula (VJAVF) and vertebral artery pseudoaneurysm (VAPA) are usually caused by iatrogenic and penetrating traumas. The concurrence of these two entities originating from the different ostia of the vertebral artery (VA) are extremely rare. The history of repeated open-heart surgeries and the applications of central venous catheterization during anesthesia increased the risk of VA injuries and its complications of the VJAVF and VAPA. The patient, who complained of of dizziness, was initially diagnosed with a bradycardia and aortic paravalvular leak.But the symptom still existed persistently even after permanent pacemaker implantation and transcatheter closure of the aortic paravalvular leak. An ultrasonography, CT angiography and intraoperative right subclavian arteriography demonstrated a VJAVF originated from the right VA, and drained into the right internal jugular vein. A VAPA originated from another ostium of the right VA without a drainage vessel. Using the endovascular technique, a 4mm-sized stent-graft was deployed in a 3.6 mm VA to cover both the VJAVF and the VAPA ostia.