Endovascular treatment of vertebral arteriovenous fistula.

The clinical and angiographic features of 46 vertebral arteriovenous fistulas (AVFs) seen during a 12-year period (45 patients) were reviewed. Fourteen patients were asymptomatic, with vertebral AVF discovered at routine clinical examination. Specific symptoms at presentation in the other patients were tinnitus (n = 21), vertigo (n = 6), neurologic deficit (n = 3), and pain (n = 2). Of the 46 AVFs, 19 (41%) were caused by trauma and 27 (59%) were spontaneous. The fistula was found at C-1 to C-2 in 21 (46%) cases, at C-2 to C-5 in five (11%), and below C-5 in 20 (44%). Thirty-four patients (35 vertebral AVFs) were treated with the endovascular technique. Embolization was performed with latex balloons filled with contrast medium in most cases. Endovascular therapy resulted in complete occlusion in 32 cases (91%) and partial occlusion in three (9%). The vertebral artery could not be preserved in three patients. Endovascular balloon treatment of vertebral AVFs is effective in occluding the shunt, avoids general anesthesia and surgical intervention, and results in minimal morbidity. Endovascular therapy is the treatment of choice for vertebral AVF.     

Percutaneous transvenous embolisation of iatrogenic vertebral arteriovenous fistula

Two patients presented with vertebral arteriovenous fistulae following unintentional puncture of the vertebral artery. A percutaneous transvenous approach was used in both cases and the fistula was successfully embolised with microcoils. A complete cure was achieved in both patients.     

Endovascular stent-graft treatment of an iatrogenic vertebral arteriovenous fistula

We present a high-flow vertebral arteriovenous fistula caused by percutaneous catheterisation of the internal jugular vein. Endovascular transarterial treatment with a self-expanding covered stent was used to close the fistula successfully with preservation of the parent artery. Received: 9 January 2001/Accepted: 30 January 2001     

Pulmonary arteriovenous fistula: detection with magnetic resonance angiography

Pulmonary arteriovenous fistula are an uncommon disorder, and are most frequently congenital, usually then associated with hereditary hemorrhagic telangectasia (Rendu-Osler-Weber disease). We present, to our knowledge, the first case of a pulmonary arteriovenous fistula detected by gadolinium-enhanced pulmonary magnetic resonance angiography and confirmed by digital subtraction pulmonary angiography in a patient where the CT scan was unremarkable. Received 18 August 1997; Revision received 27 January 1998; Accepted 28 January 1998     

Myelopathy after traumatic lumbar vertebral intraosseous arteriovenous fistula with epidural venous drainage treated with transvenous embolization

Spinal epidural arteriovenous fistulas are an uncommon entity. The authors present an interestingcase of a 48-year-old man involved in a MVC five months prior to presenting with bilateral lower extremity weakness and hypoesthesia below the knees. MRI demonstrated a flow void in the L1 vertebral body burst fracture along with a dilated basivertebral vein draining in to engorged epidural venous plexus. Angiography confirmed an intraosseous arteriovenous fistula fed by T12 and L1arteries and epidural venous drainage. Complete obliteration by arterial embolization was precluded by origin of the artery of Adamkiewicz from the feeding L1 lumbar artery. Embolization using a transvenous approach allowed for successful obliteration of the fistula. Following the procedure, the patient had significant immediate improvement in the lower extremity symptoms. This is the first report of a posttraumatic spinal epidural arteriovenous fistula secondary to a vertebral burst fracture successfully treated by transvenous embolization.     

多排螺旋CT血管造影评估血液透析患者自体动静脉内瘘功能不全

目的 探讨16排螺旋CT血管造影(CTA)对血液透析患者自体动静脉内瘘功能不全的价值.方法 21例自体动静脉内瘘功能不全的患者进行血管造影检查后,分别采用最大密度投影(MIP)和容积再现(VR) 技术对扫描的图像进行二、三维重建后处理,观察自体动静脉内瘘血管的成像情况.结果 21例患者病变血管成像清晰,显示单纯吻合口狭窄4例;流入动脉狭窄4例,其中多处狭窄3例;流出静脉狭窄7例,其中多处狭窄5例,伴有明显的静脉侧支循环4例;流入动脉及流出静脉同时狭窄2例;流入动脉、流出静脉及吻合口均狭窄2例;仅有动脉粥样斑块但无明显狭窄2例.本组合并附壁血栓6例,静脉瘤样扩张5例.结论 CTA评估血液透析患者自体动静脉内瘘功能不全,具有微创、能精准地显示内瘘血管的全貌和病变等优点.     

Digital subtraction angiography in traumatology--visualization of an arteriovenous fistula in the neck

By means of an intraarterial digital subtraction angiography a fistula due to a trauma could be visualised between the right vertebral artery and the jugular vein. The investigation was performed one year after the car accident. Visualisation with exact localisation of the beginning of the fistula at the arterial site should make it possible to perform an embolisation without affecting the vertebral artery. The clinical condition will be decisive.     

Dural arteriovenous fistula involving the transverse sigmoid sinus after treatment: assessment with magnetic resonance digital subtraction angiography

Introduction The purpose of this study was to evaluate the utility of magnetic resonance digital subtraction angiography (MRDSA) in showing the presence or absence of retrograde venous drainage (RVD) in patients with intracranial dural arteriovenous fistula (DAVF) involving the transverse sigmoid sinus (TSS) after treatment. Methods Of 16 patients with DAVF involving the TSS, 13 underwent digital subtraction angiography (DSA) and MRDSA before and after treatment, and 3 underwent DSA before treatment and DSA and MRDSA after treatment. Five patients underwent these procedures twice after treatment. A total of 21 examinations after treatment were evaluated retrospectively. The presence or absence of DAVF and RVD was decided on the basis of the DSA findings. Two neuroradiologists reviewed the MRDSA findings concerning the presence or absence of DAVF and RVD. Results DSA showed residual DAVF in 9 and residual RVD in 5 of 21 examinations. MRDSA revealed residual DAVF in 8 of 21 examinations. MRDSA did not show residual DAVF in one examination because of a very small (low-flow) residual DAVF without RVD. MRDSA identified residual RVD in 5 of 21 examinations. MRDSA was completely consistent with DSA concerning the presence or absence of residual RVD. Conclusion MRDSA could evaluate the presence or absence of RVD in patients with DAVF involving TSS after treatment. MRDSA may give reliable information as to whether patients with DAVF involving the TSS should undergo additional DSA after treatment.     

硬脑膜动静脉瘘

硬脑膜动静脉瘘(dural arteriovenous fistula,DAVF)是指动静脉交通在硬脑膜及其附属物大脑镰和小脑幕的一类血管性疾病,也称为硬脑膜动静脉畸形(DAVM).该病约占颅内血管畸形的10%～15%.     

Computed tomographic and digital subtraction angiography evaluation of ophthalmic-ethmoidal artery dural arteriovenous fistula

Ophthalmic-ethmoidal dural arteriovenous fistula (DAVFs) is a rare type of dural arteriovenous fistulas and usually presenting with spontaneous subarachnoid hemorrhage, subdural hemorrhage or ocular symptoms. We present a case of a 59-year old gentleman presenting with acute headache, vomiting and generalized weakness. CT study of the brain revealed a large left frontal hematoma and abnormal aneurysmal sac with dilated cortical vein, communicating with the superior sagittal sinus. Conventional angiography confirmed diagnosis of ruptured ophthalmic-ethmoidal DAVF, resulting in a frontal intra-axial hemorrhage. Anterior fossa DAVFs are extremely rare, difficult to diagnose and treat. CT angiography is initial method of diagnosis, but digital substruction angiography remains the gold standard of confirming dural fistulas.     

Spondylodiscitis after embolization of an extramedullary intraspinal arteriovenous fistula

The authors report a case of spondylitis Th11-Th12 occurred 1 month after embolization of an intraspinal extramedullary arteriovenous fistulae; this fistulae was fed by 11th left intercostal artery. The infecting organism isolated from the affected intervertebral disc was streptococcus sanguis a common agent of dental abscess.     

Thrombosis of aggressive dural arteriovenous fistula after incomplete embolization

We report the cases of three patients diagnosed with dural arteriovenous fistula (DAVF) and cortical venous reflux (CVR). All were treated by transarterial endovascular embolization. Residual shunting and cortical venous drainage continued to be present at the end of the treatment procedure, despite the fact that during endovascular embolization glue penetration into the proximal venous component of the fistula had been achieved. Subsequently, follow-up angiography showed total obliteration of the fistulas and absent associated CVR. The fistulas were no longer opacified, and no additional treatment was performed. We demonstrate that residual aggressive DAVF may progress to total thrombosis if strategic deposition of the glue into the venous side has been achieved. Early follow-up angiogram is recommended prior to a planned complementary surgical approach.