The direct surgical treatment of vertebral arteriovenous fistulae (AVF) presents serious difficulty and risk. Techniques for intravascular occlusion or embolization have made the treatment of AVF safer and effective. However, the occlusion of an AVF involving the segment where the vertebral vein becomes a single vessel may result in pulmonary emoblization by the occluding material. A combined procedure involving ligation of the vertebral vein and detachable balloon occlusion of the fistula was used in two instances without complications and with complete cure of the AVF. ImagesFig. 1.Fig. 2.Fig. 3.Fig. 4.Figs. 6a-b.