Spinal dural AV fistula: an unusual cause of chest pain

✓ The authors report a series of seven patients with myelopathy who were found to have spinal dural arteriovenous (AV) fistulas in which the nidus was located at some distance from the spinal cord. The nidus was intracranial in three cases and involved a sacral nerve root sheath in the other four, in each case, the arterialized draining vein led into the coronal plexus of medullary veins. A lack of normal draining radicular veins was noted in all cases. Magnetic resonance images were obtained in four patients and demonstrated spinal cord tissue changes only in the lower thoracic cord in three cases and in the cervical cord in one, all consistent with an ischemic process secondary to venous hypertension. Five patients were managed surgically by division of the draining vein, with improvement of the neurological deficit in all. One patient was treated by embolization alone and had stabilization of her deficit. The remaining patient in the series died of unrelated systemic disease before the spinal dural AV fistula could be treated. These cases support the theory that venous hypertension is the dominant pathophysiological mechanism involved in spinal dural AV fistulas independent of their location. In patients with a suspected spinal dural AV fistula, lumbar and thoracic spinal angiography will reveal the site of the fistula in the majority of cases (88% in this series). In the remaining patients, the possibility of a remote fistula must be considered. The lack of normal venous drainage of the cord following injection in the artery of Adamkiewicz is the most reliable indicator of venous hypertension in the cord and can be helpful in making the decision to proceed with a search for a cranial or sacral arterial supply.

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Spinal dural AV fistula: A nightmare for the anaesthesiologist

Sri Lankan Journal of Anaesthesiology ◽

10.4038/slja.v27i2.8428 ◽

2019 ◽

Vol 27 (2) ◽

pp. 166 ◽

Cited By ~ 1

Author(s):

Lokvendra Singh Budania ◽

M. V. Eeshwar ◽

Meghna Reddy ◽

Manjunath Prabhu ◽

Yogesh K. Gaude ◽

...

Keyword(s):

Av Fistula ◽

Spinal Dural Av Fistula

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Coronary Arteriovenous Fistula Secondary to Percutaneous Coronary Intervention of Chronic Total Occlusion

Case Reports in Vascular Medicine ◽

10.1155/2013/706820 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Seshasayee Narasimhan

Keyword(s):

Percutaneous Coronary Intervention ◽

Chest Pain ◽

Chronic Total Occlusion ◽

Coronary Intervention ◽

Total Occlusion ◽

Av Fistula ◽

Non Invasive ◽

Coronary Arteriovenous Fistula ◽

Percutaneous Coronary ◽

Maximal Medical Therapy

This is a case report of a 61-year-old female presenting with ongoing chest pain in the setting of an NSTEMI with lateral ST-T changes. On attempting to open the left circumflex (LCX), it resulted in a proximal LCX dissection. The patient remained stable with no further chest pain. She was treated with IV Eptifibatide for 48 hours and restudied in 72 hours. Repeat coronary angiography showed a marginally improved proximal dissection plane with a coronary AV fistula. She was managed conservatively and discharged with a non-invasive assessment in 8 weeks. The patient had a negative stress echocardiogram and was managed with maximal medical therapy.

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Bilateral Carotid and Vertebral Rete Mirabile Presenting with a Prominent Anterior Spinal Artery Mimicking a Spinal Dural AV Fistula at MRI

Korean Journal of Radiology ◽

10.3348/kjr.2011.12.6.740 ◽

2011 ◽

Vol 12 (6) ◽

pp. 740 ◽

Cited By ~ 12

Author(s):

Seung Young Lee ◽

Sang-Hoon Cha

Keyword(s):

Anterior Spinal Artery ◽

Av Fistula ◽

Rete Mirabile ◽

Bilateral Carotid ◽

Spinal Dural Av Fistula

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Secondary Clinical Deterioration after Successful Embolization of a Spinal Dural Arteriovenous Fistula: A Plea for Prophylactic Anticoagulation

Interventional Neuroradiology ◽

10.1177/159101991001600213 ◽

2010 ◽

Vol 16 (2) ◽

pp. 199-203 ◽

Cited By ~ 15

Author(s):

J. Knopman ◽

W. Zink ◽

A. Patsalides ◽

H.A. Riina ◽

Y.P. Gobin

Keyword(s):

Venous Thrombosis ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Spinal Dural Arteriovenous Fistula ◽

Adequate Treatment ◽

Av Fistula ◽

Time Period ◽

Systemic Anticoagulation ◽

Prophylactic Anticoagulation ◽

Spinal Dural Av Fistula

We present a case of delayed aggravation of initially-resolved symptoms in a patient after successful embolization of a T5 spinal dural arteriovenous (AV) fistula with N-butyl cyanoacrylate. The symptoms were attributed to venous thrombosis and resolved with systemic anticoagulation after five days of treatment. Although the most adequate treatment for preventing venous thrombosis after spinal dural AV fistula is not known, we describe this patient as a case for more aggressive prophylactic anticoagulation measures in the immediate post-embolization time period.

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Spinal dural AV fistula mimicking a vertebral neoplasm

Acta Radiologica ◽

10.1080/028418501127347304 ◽

2001 ◽

Vol 42 (6) ◽

pp. 618-619 ◽

Cited By ~ 1

Author(s):

D. Shetty ◽

B. Lakhkar ◽

C. Shetty ◽

S. Rai

Keyword(s):

Av Fistula ◽

Spinal Dural Av Fistula

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