scholarly journals Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas: A German Single-Center Experience

2020 ◽  
Vol 10 (2) ◽  
pp. 84-93
Author(s):  
Volker Maus ◽  
Finn Drescher ◽  
Lukas Goertz ◽  
Anushe Weber ◽  
Werner Weber ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Treatment Success ◽  
Embolic Agent ◽  
Common Symptom ◽  
Arteriovenous Fistulas ◽  
Patient Demographics ◽  
Single Center Experience ◽  
Embolic Agents ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Reflux

Background and Purpose: Intracranial dural arteriovenous fistulas (DAVFs) are abnormal shunts between dural arteries and dural venous sinus or cortical veins. We report our experience with endovascular therapy of primary complex DAVFs using modern embolic agents. Methods: This is a retrospective analysis of patients with DAVFs treated between 2015 and 2019. Patient demographics and technical aspects including the use of embolic agent, access to the fistula, number of treatments, occlusion rates, and complications were addressed. Angiographic treatment success was defined as complete occlusion (CO) of the DAVF. Results: Fifty patients were treated endovascularly. Median age was 61 years and 66% were men. The most common symptom was pulsatile tinnitus in 17 patients (34%). The most frequent location of the DAVF was the transverse-sigmoid sinus (40%). Thirty-six fistulas (72%) had cortical venous reflux. Nonadhesive and adhesive liquid agents were used in 92% as a single material or in combination. CO was achieved in 48 patients (96%). In 28 individuals (56%), only 1 procedure was necessary. Nonadhesive liquid agents were exclusively used in 14 patients (28%) with CO attained in every case. For CO of tentorial DAVFs, multiple sessions were more often required than at the other locations (55 vs. 14%, p = 0.0051). Among 93 procedures, the overall complication rate was 3%. The procedure-related mortality rate was 0%. Conclusion: Endovascular treatment of intracranial DAVFs is feasible, safe, and effective with high rates of CO. In more than half of the patients, the DAVF was completely occluded after a single procedure. However, in tentorial DAVFs, multiple sessions were more often required.

scholarly journals Endovascular treatment of cerebral dural arteriovenous fistulas with SQUID 12

2020 ◽  
Vol 26 (5) ◽  
pp. 651-657
Author(s):  
Emilio Lozupone ◽  
Sandra Bracco ◽  
Pietro Trombatore ◽  
Luca Milonia ◽  
Francesco D’Argento ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
High Rate ◽  
Embolic Agent ◽  
Complete Occlusion ◽  
Arteriovenous Fistulas ◽  
Clinical Complications ◽  
Lower Viscosity ◽  
Embolic Agents ◽  
Dural Arteriovenous Fistulas

Background Endovascular therapy with liquid embolic agents (LEAs) is the gold standard for the treatment of cerebral dural arteriovenous fistulas (cDAVFs). The aim of the study is to retrospectively evaluate effectiveness, safety, and midterm follow-up results of endovascular treatment of cDAVFs using SQUID 12. Methods Between June 2017 and January 2020 the authors retrospectively reviewed clinical, demographic and embolization data of 19 consecutive patients with cDAVF who underwent embolization using SQUID 12. The number of arteries catheterized for each procedure, the total amount of embolic agent, the occlusion rate, the injection time, any technical and/or clinical complications were recorded. Mid-term follow-up with DSA was reviewed. Results 20 procedures were performed in 19 patients. A transarterial approach was accomplished in 19 procedure; a combined transvenous-transarterial approach was realized in 1 treatment. The average time of injection was 33 minutes (2–82 minutes), and the average amount of SQUID 12 was 2.8 mL (0.5–6 mL). Complete angiographic cure at the end of the procedure was achieved in 17 patients. No major periprocedural adverse events were recorded. Mid-term follow-up was achieved in 15 out of 19 patients and confirmed complete occlusion of the cDAVFs in 13/15 patients (87%); in 2 of the initially cured patients a small relapse was detected. Conclusions The treatment of the cDAVFs using SQUID 12 was effective and safe. The lower viscosity seems to allow an easier penetration of the agent with a high rate of complete occlusion of the cDAVFs.

scholarly journals Endovascular Treatment of Dural Arteriovenous Fistulas: Single Center Experience

2015 ◽  
Vol 59 (1) ◽  
pp. 17 ◽  
Author(s):  
Jae-Sang Oh ◽  
Seok-Mann Yoon ◽  
Hyuk-Jin Oh ◽  
Jai-Joon Shim ◽  
Hack-Gun Bae ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Single Center ◽  
Arteriovenous Fistulas ◽  
Single Center Experience ◽  
Dural Arteriovenous Fistulas

scholarly journals Endovascular management of spinal dural arteriovenous fistulas

2009 ◽  
Vol 26 (5) ◽  
pp. E15 ◽  
Author(s):  
Walavan Sivakumar ◽  
Gabriel Zada ◽  
Parham Yashar ◽  
Steven L. Giannotta ◽  
George Teitelbaum ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Vascular Malformations ◽  
Endovascular Embolization ◽  
Embolic Agent ◽  
Endovascular Management ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Embolic Agents ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Object Spinal dural arteriovenous fistulas (DAVFs) are the most common spinal vascular malformations and can be a significant cause of myelopathy, yet remain inefficiently diagnosed lesions. Over the last several decades, the treatment of spinal DAVFs has improved tremendously due to improvements in neuroimaging, microsurgical, and endovascular techniques. The aim of this paper was to review the existing literature regarding the clinical characteristics, classification, and endovascular management of spinal DAVFs. Methods A search of the PubMed database from the National Library of Medicine and reference lists of all relevant articles was conducted to identify all studies pertaining to spinal DAVFs, spinal dural fistulas, and spinal vascular malformations, with particular attention to endovascular management and outcomes. Results The ability to definitively treat spinal DAVFs using endovascular embolization has significantly improved over the last several decades. Overall rates of definitive embolization of spinal DAVFs have ranged between 25 and 100%, depending in part on the embolic agent used and the use of variable stiffness microcatheters. The majority of recent studies in which N-butyl cyanoacrylate or other liquid embolic agents were used have reported success rates of 70–90%. Surgical treatment remains the definitive option in cases of failed embolization, repeated recanalization, or lesions not amenable to embolization. Clinical outcomes have been comparable to surgical treatment when the fistula and draining vein remain persistently occluded. Improvements in gait and motor function are more likely following successful treatment, whereas micturition symptoms are less likely to improve. Conclusions Endovascular embolization is an increasingly effective therapy in the treatment of spinal DAVFs, and can be used as a definitive intervention in the majority of patients that undergo modern endovascular intervention. A multidisciplinary approach to the treatment of these lesions is required, as surgery is required for refractory cases or those not amenable to embolization. Newer embolic agents, such as Onyx, hold significant promise for future therapy, yet long-term follow-up studies are required.

scholarly journals Transvenous Treatment of Cranial Dural Arteriovenous Fistulas with Hydrogel Coated Coils

2006 ◽  
Vol 12 (4) ◽  
pp. 319-326 ◽  
Author(s):  
P. Klurfan ◽  
T. Gunnarsson ◽  
I. Shelef ◽  
K.G. Terbrugge ◽  
R.A. Willinsky
Keyword(s):  
Venous Drainage ◽  
Venous Congestion ◽  
Embolic Agent ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Platinum Coil ◽  
Cortical Venous Reflux ◽  
Bare Platinum Coils ◽  
Transvenous Approach ◽  
Platinum Coils

Intracranial dural arteriovenous fistulas (DAVF) with cortical venous reflux may become symptomatic due to venous congestion or intracranial hemorrhage. Venous congestion in the orbit can also occur resulting in proptosis, chemosis, double vision and progressive visual loss. The transvenous approach has been used for selective disconnection of the venous drainage to eliminate the venous congestion and future risk of intracranial bleeding and/or neurological deficit. Hydrogel coated coils (HydroCoil®) expand after contact with blood causing the coils to swell up to five to 11 times a standard 10-system bare platinum coil. Due to this property, HydroCoils could have an advantage over platinum coils in the transvenous approach to embolization of DAVFs. Ten patients with symptomatic cranial DAVF underwent a transvenous embolization using HydroCoils as the only embolic agent or in a combination with bare platinum coils. The patients' characteristics, symptoms, angioarchitecture of the DAVF, treatment, complications and results were analyzed. All the treated DAVFs were disconnected at the end of the procedure. All the patients with orbital symptoms had complete or significant improvement. There were no periprocedural complications. Nine patients had radiological follow-up showing cure. HydroCoils can be used effectively and safely to treat intracranial DAVFs transvenously. The volume expansion of Hydrocoils may have significant advantage over bare platinum coils given the large venous spaces that need to be filled. The use of HydroCoils may decrease the procedure time and consequently reduce the radiation dose to the patient.

scholarly journals Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulas. Institutional Series, Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Andrea M. Alexandre ◽  
Carmelo Lucio Sturiale ◽  
Andrea Bartolo ◽  
Andrea Romi ◽  
Alba Scerrati ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cavernous Sinus ◽  
Meta Analysis ◽  
Complication Rates ◽  
Arteriovenous Fistulas ◽  
First Line Therapy ◽  
Ovid Medline ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Dural Arteriovenous Fistulas

Abstract Purpose Endovascular treatment represents the first-line therapy for cavernous sinus dural arteriovenous fistulas (CS-dAVF); however, different approaches and embolic agents as well as occlusion rates, complications and clinical outcomes are reported among the published series. In this study we performed a comprehensive meta-analysis to investigate clinical and radiological outcomes after endovascular treatment of CS-dAVFs. Methods PubMed, Ovid Medline, Ovid EMBASE, Scopus, and Web of Science were screened for a comprehensive literature review from 1990 to 2020 regarding series of patients treated for CS-dAVF with endovascular approaches. We performed a proportion meta-analysis estimating the pooled rates of each outcome also including data of patients treated in our center. Results A total of 22 studies reporting 1043 patients and 1066 procedures were included. Chemosis was reported in 559 out of 1043 patients (45.9%), proptosis in 498 (41.5%), and ophthalmoplegia in 344 (23.5%). A transvenous embolization was preferred in 753 cases (63.2%) and coils were used in 712 out of 1066 procedures (57.8%). Overall, 85% (95% confidence interval, CI 69.5–96.1%) of patients had a complete resolution of symptoms, while complications occurred in 7.75% (95% CI 3.82–12.7%) with minimal permanent deficits (0.15%). The mortality rate was 1 out of 1043 patients (< 0.001). Conclusion A transvenous coiling is the most common endovascular approach for CS-dAVF, achieving a high percentage of radiological and clinical resolution and low complication rates. Transvenous approaches show less complications than transarterial ones, and coils appear safer than liquid embolic agents.

scholarly journals Glue, Onyx, Squid or PHIL? Liquid Embolic Agents for the Embolization of Cerebral Arteriovenous Malformations and Dural Arteriovenous Fistulas

2021 ◽  
Author(s):  
Dominik F. Vollherbst ◽  
René Chapot ◽  
Martin Bendszus ◽  
Markus A. Möhlenbruch
Keyword(s):  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Endovascular Embolization ◽  
Embolic Agent ◽  
Cerebral Arteriovenous Malformations ◽  
Arteriovenous Fistulas ◽  
Advantages And Disadvantages ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Dural Arteriovenous Fistulas

Abstract Background Endovascular embolization is an effective treatment option for cerebral arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs). A variety of liquid embolic agents have been and are currently used for embolization of AVMs and DAVFs. Knowledge of the special properties of the agent which is used is crucial for an effective and safe embolization procedure. Material and Methods This article describes the properties and indications of the liquid embolic agents which are currently available: cyanoacrylates (also called glues), and the copolymers Onyx, Squid and PHIL, as well as their respective subtypes. Results Cyanoacrylates were the predominantly used agents in the 1980s and 1990s. They are currently still used in specific situations, for example for the occlusion of macro-shunts, for the pressure cooker technique or in cases in which microcatheters are used that are not compatible with dimethyl-sulfoxide. The first broadly used copolymer-based embolic agent Onyx benefits from a large amount of available experience and data, which demonstrated its safety and efficacy in the treatment of cerebral vascular malformations, while its drawbacks include temporary loss of visibility during longer injections and artifacts in cross-sectional imaging. The more recently introduced agents Squid and PHIL aim to overcome these shortcomings and to improve the success rate of endovascular embolization. Novelties of these newer agents with potential advantages include extra-low viscosity versions, more stable visibility, and a lower degree of imaging artifacts. Conclusion All the available liquid embolic agents feature specific potential advantages and disadvantages over each other. The choice of the most appropriate embolic agent must be made based on the specific material characteristics of the agent, related to the specific anatomical characteristics of the target pathology.

Endovascular treatment of cribriform plate dural arteriovenous fistulas: technical difficulties and complications avoidance

2015 ◽  
Vol 8 (9) ◽  
pp. 954-958 ◽  
Author(s):  
Thomas Robert ◽  
Raphaël Blanc ◽  
Stanislas Smajda ◽  
Gabriele Ciccio ◽  
Hocine Redjem ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Venous Drainage ◽  
Middle Meningeal Artery ◽  
Cribriform Plate ◽  
Embolic Agent ◽  
Arteriovenous Fistulas ◽  
Technological Advances ◽  
Embolic Agents ◽  
Ethmoidal Artery ◽  
Meningeal Artery

ObjectiveCribriform plate dural arteriovenous fistula (dAVF) is a rare pathology, for which the treatment of choice used to be neurosurgery. Technological advances in micro-catheters and embolic agents permitted new endovascular alternatives.MethodsWe included all patients treated endovascularly for a cribriform plate dAVF between 2008 and 2013. We retrospectively analysed data focusing on the type of treatment chosen.ResultsTen patients were treated by endovascular approach, with a need for an additional surgical exclusion of the fistula in two cases. Thirteen embolisation sessions were done. Embolisation of the fistula through an ethmoidal artery was the technique of choice; the catheterism of the ophthalmic artery was impossible in two cases and the embolic agent did not penetrate in four cases. The embolisation through the middle meningeal artery was successful in one case but the tortuosity of this artery prevented good penetration of the embolic agent. Venous approach was successful in all cases but was limited to fistulas with superficial venous drainage.ConclusionsEndovascular treatment of cribriform plate dAVF is safe and effective. The embolisation through ethmoidal artery is the method of choice. Branches of the middle meningeal artery are tortuous and prevent the penetration of embolic agent. Venous approach is effective but is limited to cases of failure of the arterial approach.

Preliminary experience with the liquid embolic material agent PHIL (Precipitating Hydrophobic Injectable Liquid) in treating cranial and spinal dural arteriovenous fistulas: technical note

2015 ◽  
Vol 8 (6) ◽  
pp. 596-602 ◽  
Author(s):  
Joe J Leyon ◽  
Swarupsinh Chavda ◽  
Allan Thomas ◽  
Saleh Lamin
Keyword(s):  
Interventional Neuroradiology ◽  
Technical Note ◽  
Embolic Agent ◽  
Embolic Material ◽  
Arteriovenous Fistulas ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Dural Arteriovenous Fistulas ◽  
Fluoroscopic Time ◽  
Liquid Embolic Agent

BackgroundLiquid embolic agents are the preferred embolic material in endovascular treatment of pial and brain arteriovenous malformations and dural arteriovenous fistulas (DAVFs). There is little choice available in interventional neuroradiology practice other than two of the most commonly used liquid embolic agents—n-butyl cyanoacrylate and the Onyx liquid embolic system (ev3 Neurovascular, Irvine, California, USA). PHIL (Precipitating Hydrophobic Injectable Liquid) (Microvention, Inc California, USA) is a new liquid embolic agent, CE marked and available for clinical use in Europe.ObjectiveTo present our preliminary experience using PHIL in treating cranial and spinal DAVFs.MethodsBetween September 2014 and January 2015, eight patients, with five cranial DAVFs and three spinal DAVFs were treated with PHIL as the sole embolic agent used with intent to cure. Clinical presentation, location of DAVF, Borden type, fluoroscopic time, radiation dose, procedural time, injecting microcatheter used, volume of PHIL injected, complications, immediate angiographic data, premorbid and discharge modified Rankin Scale score, and any neurologic deficits were included in the analysis.ResultsSeven patients were successfully treated with complete angiographic exclusion of the fistula in a single sitting. Treatment failed in one patient where only suboptimal microcatheter positioning could be achieved and PHIL failed to penetrate the fistula's nidus. Venous penetration was achieved in all other patients except one with a small fistula, but with adequate fistula penetration by the embolic material. No other technical complication or neurologic deterioration occurred in any of the patients.ConclusionsPHIL liquid embolic agent appears to be an excellent alternative embolic material with certain advantages compared with other available liquid embolic agents. Further studies are required to fully evaluate its safety and efficacy.

scholarly journals Neurosurgical versus endovascular treatment of spinal dural arteriovenous fistulas: a multicenter study of 195 patients

2020 ◽  
pp. 1-8
Author(s):  
Keisuke Takai ◽  
Toshiki Endo ◽  
Takao Yasuhara ◽  
Toshitaka Seki ◽  
Kei Watanabe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Failure ◽  
Endovascular Treatment ◽  
Initial Treatment ◽  
Treatment Success ◽  
Symptom Duration ◽  
Treatment Groups ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

OBJECTIVEThe purpose of the present study was to compare the treatment success rates of primary neurosurgical and endovascular treatments in patients with spinal dural arteriovenous fistulas (dAVFs).METHODSData from 199 consecutive patients with thoracic and lumbosacral spinal dAVFs were collected from 18 centers. Angiographic and clinical findings, the rate of initial treatment failure or recurrence by procedures, risk factors for treatment failure, complications, and neurological outcomes were statistically analyzed.RESULTSSpinal dAVFs were frequently detected in the thoracic region (81%), fed by a single feeder (86%), and shunted into an intradural vein via the dura mater. The fistulous connection between the feeder(s) and intradural vein was located at a single spinal level in 195 patients (98%) and at 2 independent levels in 4 patients (2%). Among the neurosurgical (n = 145), and endovascular (n = 50) treatment groups of single dAVFs (n = 195), the rate of initial treatment failure or recurrence was significantly higher in the index endovascular treatment group (0.68% and 36%). A multivariate analysis identified endovascular treatment as an independent risk factor with significantly higher odds of initial treatment failure or recurrence (OR 69; 95% CI 8.7–546). The rate of complications did not significantly differ between the two treatment groups (4.1% for neurosurgical vs 4.0% for endovascular treatment). With a median follow-up of 26 months, improvements of ≥ 1 point in the modified Rankin Scale (mRS) score and Aminoff-Logue gait and Aminoff-Logue micturition grades were observed in 111 (56%), 121 (61%), and 79 (40%) patients, respectively. Independent risk factors for lack of improvement in the Aminoff-Logue gait grades were multiple treatments due to initial treatment failure or recurrence (OR 3.1) and symptom duration (OR 1.02).CONCLUSIONSBased on data obtained from the largest and most recently assessed multicenter cohort, the present study shows that primary neurosurgery is superior to endovascular treatment for the complete obliteration of spinal dAVFs by a single procedure.

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