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

Visish M. Srinivasan, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , AZ , USA.
Katherine Karahalios, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , AZ , USA.
Marco Colasurdo, Department of Neurosurgery, University of Texas Medical Branch, Galveston , TX , USA.
Emmajane Rhodenheiser, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , AZ , USA.
Lea Scherschinski, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , AZ , USA.
Tyler T. Lazaro, Department of Neurosurgery, Baylor College of Medicine, Houston , TX , USA.
Gustavo Cortez, Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville , FL , USA.
Bradley A. Gross, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , PA , USA.
Anna Luisa Kühn, Department of Radiology, University of Massachusetts Medical School, Worcester , MA , USA.
Ajit Puri, Department of Radiology, University of Massachusetts Medical School, Worcester , MA , USA.
Ethan A. Winkler, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , AZ , USA.
Joshua S. Catapano, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , AZ , USA.
Yosuke Akamatsu, Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston , MA , USA.
Ajith Thomas, Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston , MA , USA.
Ricardo A. Hanel, Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville , FL , USA.
Ajay Wakhloo, Department of Neurointerventional Radiology, Lahey Hospital and Medical Center, Tufts University School of Medicine, Burlington , MA , USA.
Ashutosh P. Jadhav, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , AZ , USA.
Andrew F. Ducruet, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , AZ , USA.Follow
Felipe C. Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , AZ , USA.
Peter Kan, Department of Neurosurgery, University of Texas Medical Branch, Galveston , TX , USA.

Document Type

Article

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.

Publication Date

12-1-2023

Publication Title

Operative neurosurgery (Hagerstown, Md.)

E-ISSN

2332-4260

Volume

25

Issue

6

First Page

489

Last Page

498

PubMed ID

37747335

Digital Object Identifier (DOI)

10.1227/ons.0000000000000873

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