Publication

Transvenous Embolization of Dural Arteriovenous Fistulas Through the Galenic (Deep Venous) System: Multicenter Case Series and Meta-Analysis

Srinivasan, Visish M
Karahalios, Katherine
Colasurdo, Marco
Rhodenheiser, Emmajane
Scherschinski, Lea
Lazaro, Tyler T
Cortez, Gustavo
Gross, Bradley A
Kuhn, Anna Luisa
Puri, Ajit S
... show 10 more
Embargo Expiration Date
Abstract

Background and objectives: Arteriovenous fistulas involving the deep venous system have often been treated with microsurgery or transarterial embolization. Increasing familiarity with transvenous navigation and improved endovascular access systems may facilitate transvenous embolization (TVE) for these rare and challenging lesions.

Methods: We performed a retrospective study of neurointerventional databases of 6 high-volume centers. We identified all cases of arteriovenous fistulas with deep transvenous embolizations for arteriovenous fistula. Details regarding demographics, fistula characteristics, treatment considerations, clinical outcomes, and fistula occlusion were obtained and analyzed. The meta-analysis used the same inclusion criteria.

Results: Seventeen cases of TVE were identified. The most common reasons for TVE included prior treatment failure with microsurgery (n = 2) or transarterial embolization (n = 3) or inaccessible arterial pedicles (n = 4). For patients with full clinical outcome data (n = 14), 2 patients had worsened modified Rankin Scale, 8 patients had no change, and 4 were improved at a median clinical follow-up of 3.5 months. Angiographic obliteration was achieved in 15/17 cases (88.2%). In 1 case, catheterization around a sharp turn in the basal vein of Rosenthal could not be performed. In another case, despite successful TVE, there was residual lesion which was treated 1 year later by microsurgical clipping and excision.

Conclusion: Transvenous approaches for embolization of deep arteriovenous fistulas have become possible with modern endovascular catheter systems and liquid embolics. These lesions can be treated safely and effectively through endovascular approaches, which may spare patients the traversal of deep structures needed for microsurgical approaches to these regions. The outcomes of TVE are comparable with published outcomes of microsurgical interruption.

Source

Srinivasan VM, Karahalios K, Colasurdo M, Rhodenheiser E, Scherschinski L, Lazaro TT, Cortez G, Gross BA, Kühn AL, Puri A, Winkler EA, Catapano JS, Akamatsu Y, Thomas A, Hanel RA, Wakhloo A, Jadhav AP, Ducruet AF, Albuquerque FC, Kan P. Transvenous Embolization of Dural Arteriovenous Fistulas Through the Galenic (Deep Venous) System: Multicenter Case Series and Meta-Analysis. Oper Neurosurg (Hagerstown). 2023 Sep 25. doi: 10.1227/ons.0000000000000873. Epub ahead of print. PMID: 37747335.

Year of Medical School at Time of Visit
Sponsors
Dates of Travel
DOI
10.1227/ons.0000000000000873
PubMed ID
37747335
Other Identifiers
Notes
Funding and Acknowledgements
Corresponding Author
Related Resources
Related Resources
Repository Citation
Rights
Copyright © Congress of Neurological Surgeons 2023. All rights reserved.
Distribution License