Usefulness of three-dimensional digital subtraction angiography in endovascular treatment of a spinal dural arteriovenous fistula

2008 ◽  
Vol 8 (5) ◽  
pp. 462-467 ◽  
Author(s):  
Noriaki Matsubara ◽  
Shigeru Miyachi ◽  
Takashi Izumi ◽  
Tomotaka Ohshima ◽  
Arihito Tsurumi ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Bone Structure ◽  
Maximum Intensity Projection ◽  
Endovascular Embolization ◽  
Intercostal Artery ◽  
Digital Subtraction ◽  
Spinal Dural Arteriovenous Fistula ◽  
The Relationship

✓The use of 3D digital subtraction (DS) angiography provides a better understanding of spinal vascular lesion architecture. The authors report on 2 cases involving a spinal dural arteriovenous fistula (DAVF) and demonstrate the usefulness of 3D DS angiography for endovascular treatment of these spinal DAVFs. In both cases, middle-aged male patients suffered from bilateral leg hypesthesia, gait disturbance, and urinary dysfunction several months before treatment. Spinal angiography revealed DAVFs that were fed by a radicular artery branching from the intercostal artery and draining veins proceeding superiorly along the perimedullary veins. Endovascular embolization was performed in both cases. Selective 3D DS angiography of the intercostal artery clearly demonstrated the tortuous course of the feeder and the relationship among the feeding artery, fistula point, and draining veins in each case. This information was very useful in selecting a working angle for manipulating the microcatheter and for glue injection. In addition, the maximum intensity projection image from rotational DS angiography data clearly showed the fistula point at the dural sleeve and feeder entering the spinal canal via the intervertebral foramen and the relationship with the bone structure. Successful obliteration of the fistulae was achieved in both cases. Selective spinal 3D DS angiography was very useful in understanding the complex spinal vascular architecture and in choosing the best working angle and therapeutic strategy for endovascular treatment of spinal DAVFs.

Intraoperative Spinal Angiography during Microsurgical Occlusion of Spinal Dural Arteriovenous Fistula within the Hybrid Operation Room

2021 ◽  
Author(s):  
Jenny Christine Kienzler ◽  
Salome Schoepf ◽  
Serge Marbacher ◽  
Michael Diepers ◽  
Luca Remonda ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Prone Position ◽  
Popliteal Artery ◽  
Dural Arteriovenous Fistula ◽  
Endovascular Embolization ◽  
Treatment Modalities ◽  
Safe Procedure ◽  
Spinal Dural Arteriovenous Fistula ◽  
Segmental Artery ◽  
Small Branch

Abstract Background Spinal dural arteriovenous fistula (SDAVF) is a rare cause of progressive myelopathy in predominantly middle-aged men. Treatment modalities include surgical obliteration and endovascular embolization. In surgically treated cases, failure of obliteration is reported in up to 5%. The aim of this technical note is to present a safe procedure with complete SDAVF occlusion, verified by intraoperative digital subtraction angiography (DSA). Methods We describe four patients with progressive leg weakness who underwent surgical obliteration of SDAVF with spinal intraoperative DSA in the prone position after cannulation of the popliteal artery. All surgeries took place in our hybrid operating room (OR) and were accompanied by electrophysiologic monitoring. Surgeries and cannulation of the popliteal artery were performed in the prone position. Ultrasound was used to guide the popliteal artery puncture. A 5-Fr sheath was inserted and the fistula was displayed using a 5-Fr spinal catheter. Spinal intraoperative DSA was performed prior to and after temporary clipping of the fistula point as well after the final SDAVF occlusion. Results The main feeder of the SDAVF fistula in the first patient arose from the right T11 segmental artery, which also supplied the artery of Adamkiewicz. The second patient initially underwent endovascular treatment and deteriorated 5 months later due to recanalization of the SDAVF via a small branch of the T12 segmental artery. The third and fourth cases were primarily scheduled for surgical occlusion. Access through the popliteal artery for spinal intraoperative DSA proved to be beneficial and safe in the hybrid OR setting, allowing the sheath to be left in place during the procedure. During exposure and after temporary and permanent occlusion of the fistulous point, intraoperative indocyanine green (ICG) video angiography was also performed. In one case, the addition of intraoperative DSA showed failure of fistula occlusion, which was not visible with ICG angiography, leading to repositioning of the clip. Complete fistula occlusion was documented in all cases. Conclusion Spinal intraoperative DSA in the prone position is a feasible and safe intervention for rapid localization and confirmation of surgical SDAVF occlusion.

scholarly journals Paraplegia after contrast media application: a transient or devastating rare complication? Case report

2016 ◽  
Vol 24 (5) ◽  
pp. 806-809 ◽  
Author(s):  
Dorothee Mielke ◽  
Kai Kallenberg ◽  
Marius Hartmann ◽  
Veit Rohde
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Contrast Media ◽  
Arteriovenous Fistula ◽  
Digital Subtraction Angiography ◽  
Dural Arteriovenous Fistula ◽  
Rare Complication ◽  
Digital Subtraction ◽  
Spinal Dural Arteriovenous Fistula ◽  
The Individual

The authors report the case of a 76-year-old man with a spinal dural arteriovenous fistula. The patient suffered from sudden repeated reversible paraplegia after spinal digital subtraction angiography as well as CT angiography. Neurotoxicity of contrast media (CM) is the most probable cause for this repeated short-lasting paraplegia. Intolerance to toxicity of CM to the vulnerable spinal cord is rare, and probably depends on the individual patient. This phenomenon is transient and can occur after both intraarterial and intravenous CM application.

Endovascular treatment of complex dural arteriovenous fistula using the dual-microcatheter technique

2014 ◽  
Vol 37 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Michael R. Levitt ◽  
Joshua W. Osbun ◽  
John D. Nerva ◽  
Louis J. Kim
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Jugular Bulb ◽  
Endovascular Embolization ◽  
Venous Hypertension ◽  
Lost To Follow Up ◽  
Onyx Copolymer

A 71-year-old woman presented with headache and dilated vessels on CTA. Angiography demonstrated a complex dural arteriovenous fistula with retrograde cortical venous hypertension, supplied by branches of internal and external carotids bilaterally into a fistulous pouch paralleling the left transverse and sigmoid sinuses, which was occluded at the jugular bulb. The patient refused treatment and was lost to follow-up, returning with sudden confusion and hemianopsia from left temporo-occipital hemorrhage. Transvenous endovascular embolization was performed using the dual-microcatheter technique with a combination of coiling and Onyx copolymer, completely occluding the sinus and fistula while preserving normal venous drainage.The video can be found here: http://youtu.be/u_4Oc7tSmDM.

scholarly journals Spinal dural arteriovenous fistula presenting as low back pain

2018 ◽  
Vol 26 (4) ◽  
pp. 250-253
Author(s):  
Kwok-Chun Chan ◽  
Fu-Jen Cheng ◽  
Chih-Wei Hsu ◽  
I-Ting Tsai ◽  
Choon-Bing Chua ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Low Back Pain ◽  
Back Pain ◽  
Magnetic Resonance ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Endovascular Embolization ◽  
Low Back ◽  
Resonance Imaging ◽  
Spinal Dural Arteriovenous Fistula

Introduction: Low back pain or numbness of the lower extremities is quite common in the present population. Numerous conditions may cause these symptoms, including spinal vascular anomaly. Identifying and diagnosing the cause of these symptoms are crucial for treatment. Accurate diagnosis based on particular radiological findings in magnetic resonance imaging is crucial for administering adequate therapy to patients, especially in spinal dural arteriovenous fistula. Case presentation: We report a case presenting with low back pain and rapid deterioration in paraplegia. Magnetic resonance imaging provided the typical image presentations such as spinal cord edema with tortuous dilated perimedullary venous plexus. The patient was subsequently successfully treated with endovascular embolization. Discussion: Spinal dural arteriovenous fistula should be suspected in any patient who presents with myelopathy. Angiography remains the gold standard for confirmation of diagnosis. Conclusion: Prompt treatment with endovascular embolization or surgery could improve patients’ outcomes.

Sign in / Sign up

Export Citation Format

Share Document