Endovascular treatment of vertebral arteriovenous fistula using an occlude

The search for the optimal approach in the treatment of brachiocephalic arteriovenous fistulas is one of the current problems of neurosurgery and vascular surgery. It is important to note that the best prognosis requires timely diagnosis and the earliest possible dissection of the fistula. Also, the method of treatment should have the least negative consequences and a good clinical effect. Previously, surgeons used open surgical vessel ligation with great technical difficulties due to anatomical difficulties of access as well as bleeding. In recent decades, the endovascular approach to treatment has demonstrated advantages over open interventions. Despite the low traumaticity, there is a risk of complications such as untargeted vascular embolization, perioperative stroke, etc. In this article we demonstrate the experience of arterio-venous vertebral artery fistula dissection using an occluder.

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Combined surgical/endovascular treatment of a complex dural arteriovenous fistula in 21-month-old

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.2.peds08469 ◽

2009 ◽

Vol 3 (6) ◽

pp. 501-506 ◽

Cited By ~ 6

Author(s):

R. Webster Crowley ◽

Avery J. Evans ◽

Mary E. Jensen ◽

Neal F. Kassell ◽

Aaron S. Dumont

Keyword(s):

Endovascular Treatment ◽

Transarterial Embolization ◽

Treatment Options ◽

Endovascular Techniques ◽

Vascular Abnormalities ◽

Arteriovenous Fistulas ◽

The Past ◽

Endovascular Approach ◽

Embolic Materials ◽

Extensive Surgery

The treatment of intracranial dural arteriovenous fistulas (AVF) has progressed considerably over the past few decades. With the introduction of new embolic materials and refinement of endovascular techniques, lesions that in the past may have required extensive surgery, or were considered untreatable, have increasingly become curable. Despite improvements in technology, not every condition is amenable to an endovascular treatment, including those patients with preexisting vascular abnormalities that preclude an endovascular approach. In these cases, the patient may be left with suboptimal treatment options with higher associated risks. The authors here report on the treatment of a dural AVF in a pediatric patient in whom prior procedures rendered his cerebrovascular anatomy unnavigable using traditional endovascular techniques. To circumvent these vascular abnormalities the patient underwent combined surgical/endovascular treatment that included surgical exposure and cannulation of the cervical carotid artery, as well as simultaneous femoral artery access, with subsequent successful transarterial embolization of the dural AVF.

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Lower vertebral-epidural spinal arteriovenous fistulas: a unique subtype of vertebrovertebral arteriovenous fistula, treatable with coil and Penumbra Occlusion Device embolization

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011677 ◽

2015 ◽

Vol 8 (6) ◽

pp. 643-647 ◽

Cited By ~ 9

Author(s):

Ramsey Ashour ◽

Darren B Orbach

Keyword(s):

Vertebral Artery ◽

Arteriovenous Fistula ◽

Venous Drainage ◽

Venous Plexus ◽

Arteriovenous Fistulas ◽

Spinal Arteriovenous Fistula ◽

Occlusion Device ◽

Device Embolization ◽

Endovascular Approach ◽

Spinal Epidural

A vertebral-epidural spinal arteriovenous fistula (AVF) is an abnormal arteriovenous shunt connecting the vertebral artery to the spinal epidural venous plexus, and may occur spontaneously or secondary to a variety of causes. These unique lesions are uncommon in adults and rarer still in children. Previous reports have grouped together a heterogeneous collection of such arteriovenous lesions, including arterial contributions from the upper and lower vertebral artery, with venous drainage into a variety of spinal and paraspinal collectors. Here, through two cases, we delineate a distinct entity, the lower vertebral-to-epidural AVF. The salient clinical and anatomic features are summarized and contextualized within the broader constellation of vertebrovertebral AVF, the utility of a transarterial intravenous/retrograde intra-arterial endovascular approach is highlighted, and a new use of the Penumbra Occlusion Device (Penumbra Inc) for this purpose is reported.

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Arteriovenous fistulas of the Vein of Galen region in adults: Endovascular treatment

Interventional Neuroradiology ◽

10.1177/1591019920940495 ◽

2020 ◽

Vol 26 (6) ◽

pp. 757-766

Author(s):

Laura Paúl ◽

Alfredo Casasco ◽

Alberto Gil ◽

Aitziber Aleu ◽

Leopoldo Guimaraens

Keyword(s):

Endovascular Treatment ◽

Complete Resolution ◽

Therapeutic Strategy ◽

Clinical Presentation ◽

Venous Drainage ◽

Vein Of Galen ◽

Arteriovenous Fistulas ◽

Complete Obliteration ◽

Endovascular Approach ◽

Low Prevalence

Purpose Arteriovenous fistulas of the Vein of Galen region in adults (Ad-VGAVF) are an uncommon entity with specific anatomic features. The aim of this article is to present our experience in the endovascular treatment of this pathology and to propose a therapeutic strategy based precisely on the angioarchitecture of these lesions. Materials and methods During a 20-year period, 10 patients underwent endovascular treatment of Ad-VGAVF. They were nine men and one woman with a mean age of 50 years (23–66 years) treated with the same embolization strategy. Clinical presentation, angiographic characteristics, therapeutic strategy, and clinical outcomes were recorded. Results All patients were treated exclusively by endovascular approach. Transarterial access was performed in eight patients and combined transvenous and transarterial access in two. Complete obliteration of the fistula was obtained in all patients. There were no intraprocedural complications. Post-embolization neurological symptoms occurred in 5 of 10 with complete resolution at six months in all of them. Conclusion Arteriovenous fistulas of the Vein of Galen region in adults present uniform angioarchitecture despite their low prevalence. Based on this constant angioarchitecture and especially on the features of its venous drainage, judicious embolization strategy is feasible and effective. Ten cases treated entirely by endovascular approach with excellent clinical and angiographic outcomes show this treatment like a curative alternative for this entity of deep topography and severe prognosis.

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Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas

Neurosurgery ◽

10.1227/neu.0000000000000180 ◽

2014 ◽

Vol 74 (suppl_1) ◽

pp. S42-S49 ◽

Cited By ~ 18

Author(s):

Matthew VanLandingham ◽

Benjamin Fox ◽

Daniel Hoit ◽

Lucas Elijovich ◽

Adam S. Arthur

Keyword(s):

Endovascular Treatment ◽

Treatment Options ◽

Imaging Systems ◽

Arteriovenous Fistulas ◽

Hybrid Approaches ◽

Liquid Embolic ◽

Dural Arteriovenous Fistulas ◽

Endovascular Approach ◽

Vascular Structures ◽

Catheter Technology

Abstract Endovascular treatment options for dural arteriovenous fistulas (DAVFs) have vastly expanded and become progressively safer in the last several years. Angiographic imaging systems have improved, catheter technology has advanced, and liquid embolic and coil options have increased. As a likely result, an increasing proportion of DAVFs are treated via an endovascular approach. In addition to allowing physicians to appreciate and treat lesions better, varied approaches have been developed. The “plug and push” technique and the new availability of dimethyl sulfoxide--compatible dual lumen balloons have allowed safer and more thorough transarterial treatments. Transvenous treatment has proved to be a valuable technique for some lesions. Hybrid approaches with surgical assisted access to vascular structures have been successfully used to treat more challenging fistulas.

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Faculty Opinions recommendation of Editor's Choice - Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS).

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.730661465.793576900 ◽

2020 ◽

Author(s):

Seemant Chaturvedi

Keyword(s):

Clinical Practice ◽

Vascular Surgery ◽

Vertebral Artery ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

European Society ◽

Artery Disease

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Endovascular Treatment for Tentorial Dural Arteriovenous Fistulas

Surgery for Cerebral Stroke ◽

10.2335/scs.38.235 ◽

2010 ◽

Vol 38 (4) ◽

pp. 235-242 ◽

Cited By ~ 1

Author(s):

Naoko MIYAMOTO ◽

Isao NAITO ◽

Shin TAKATAMA ◽

Tomoyuki IWAI ◽

Masahiro MATSUMOTO ◽

...

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas

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Endovascular treatment of the vertebral artery origin stenosis by using the closed-cell, self-expandable Carotid Wallstent

Interventional Neuroradiology ◽

10.1177/1591019920935276 ◽

2020 ◽

Vol 26 (6) ◽

pp. 805-813

Author(s):

Jun-Kyeung Ko ◽

Chang-Hwa Choi ◽

Lee Hwangbo ◽

Hie-Bum Suh ◽

Tae-Hong Lee ◽

...

Keyword(s):

Endovascular Treatment ◽

Vertebral Artery ◽

Good Alternative ◽

Minor Stroke ◽

Stent Restenosis ◽

Vertebrobasilar Ischemia ◽

Closed Cell ◽

Carotid Wallstent ◽

Permanent Neurological Deficit

Background Endovascular treatment has been considered a good alternative to surgery for symptomatic vertebral artery origin stenosis (VAOS) due to the high risk of morbidity associated with surgery. The purpose of this study was to evaluate the feasibility and efficacy of insertion of the closed-cell, self-expandable Carotid Wallstent for the treatment of VAOS. Methods The records of 72 patients with VAOS refractory to adequate medication who were treated by endovascular treatment with the Carotid Wallstent from December 2006 to November 2018 were retrospectively evaluated. Results Of the 72 patients, 43 presented with transient ischemic attacks. Forty-seven patients (65.3%) manifested other brachiocephalic stenoses; of these, 40 patients had occlusion, hypoplasia, or stenosis of the contralateral vertebral artery. Overall technical success (defined as 20% or less residual stenosis) was 100%. Procedure-related complications ( n = 8, 11.1%) included sudden asystole ( n = 1), acute in-stent thrombosis ( n = 3), minor stroke ( n = 3), and stent shortening ( n = 1). All complications were resolved without permanent neurological deficit. Angiographic follow-up (mean, 13.0 months) was achieved in 49 patients and revealed in-stent restenosis in 1 patient (2.0%) and stent malposition by shortening in 2 patients (4.1%). Follow-up records were available in 57 patients (mean 15.6 months). Three of the 57 patients ( n = 3, 5.3%) had recurrent symptoms of vertebrobasilar ischemia and none was retreated. Conclusions Endovascular treatment of symptomatic VAOS using the closed-cell, self-expandable Carotid Wallstent is technically feasible and effective in alleviating patient symptoms and for improving vertebrobasilar blood flow.

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