Comparative analysis of spinal extradural arteriovenous fistulas with or without intradural venous drainage: a systematic literature review

2012 ◽  
Vol 32 (5) ◽  
pp. E8 ◽  
Author(s):  
Keisuke Takai ◽  
Makoto Taniguchi
Keyword(s):  
Comparative Analysis ◽  
Signal Intensity ◽  
Case Reports ◽  
Case Series ◽  
Venous Drainage ◽  
Type A ◽  
Mass Effect ◽  
Type B ◽  
Venous Plexus ◽  
Arteriovenous Fistulas

Object Spinal arteriovenous malformations (AVMs) are classified into types according to anatomical characteristics: dural arteriovenous fistulas (AVFs), intramedullary AVMs, perimedullary AVFs, and extradural AVFs. Spinal extradural AVFs are much rarer than other types of spinal AVMs, and the available literature on this clinical entity has been based only on case reports or small case series. To investigate the clinical characteristics of patients with spinal extradural AVFs, the authors systematically reviewed the associated literature in the MRI era. Methods The PubMed database was searched for all relevant English-language case reports and case series published from 1990 to 2011. The clinical differences between Type A with and Type B without intradural venous drainage were statistically compared, especially regarding clinical features and angiographic and MRI findings. Results Forty-five cases of spinal extradural AVFs were found. Type A spinal extradural AVFs were diagnosed in patients with a significantly older age (mean 63.5 years) as compared with Type B AVFs (mean 34.3 years, p < 0.0001). Most cases of Type A spinal extradural AVFs exhibited a diffuse high signal intensity of the spinal cord on T2-weighted MR images and no mass effect (p < 0.0001), and they commonly occurred in the thoracolumbar and lumbar regions (p < 0.0001). On the other hand, cases of Type B lesions exhibited a normal signal intensity of the cord with severe mass effect due to an enlarged extradural venous plexus, and they commonly occurred in the cervical and upper thoracic regions (p < 0.0001), frequently in patients with neurofibromatosis Type 1 (p = 0.049). Because Type B AVFs consisted of high-flow, multiple complex anastomoses between arteries and the epidural venous plexus, patients with these lesions tended to undergo multisession treatments, and the rate of partial AVF occlusion was significantly higher than for Type A AVFs (p = 0.018), although there was no difference in symptom outcomes between the 2 groups. Conclusions To the best of the authors' knowledge, a comparative analysis of the clinical differences in patients with extradural AVFs with or without intradural venous drainage has yet to be described in the literature. They concluded that in the diagnosis of spinal extradural AVF, evaluation of intradural venous drainage is important because the cause of myelopathy determines the treatment goals.

scholarly journals Using pCO2 Gap in the Differential Diagnosis of Hyperlactatemia Outside the Context of Sepsis: A Physiological Review and Case Series

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Petr Waldauf ◽  
Katerina Jiroutkova ◽  
Frantisek Duska
Keyword(s):  
Cardiac Output ◽  
Lactic Acidosis ◽  
Critically Ill ◽  
Case Reports ◽  
Case Series ◽  
Type A ◽  
Physiological Data ◽  
Type B ◽  
Central Venous ◽  
Content Difference

Introduction. There is an inverse relationship between cardiac output and the central venous-arterial difference of partial pressures of carbon dioxide (pCO2 gap), and pCO2 gap has been used to guide early resuscitation of septic shock. It can be hypothesized that pCO2 gap can be used outside the context of sepsis to distinguish type A and type B lactic acidosis and thereby avoid unnecessary fluid resuscitation in patients with high lactate, but without organ hypoperfusion. Methods. We performed a structured review of the literature enlightening the physiological background. Next, we retrospectively selected a series of case reports of nonseptic critically ill patients with elevated lactate, in whom both arterial and central venous blood gases were simultaneously measured and the diagnosis of either type A or type B hyperlactataemia was conclusively known. In these cases, we calculated venous-arterial CO2 and O2 content differences and pCO2 gap. Results. Based on available physiological data, pCO2 can be considered as an acceptable surrogate of venous-arterial CO2 content difference, and it should better reflect cardiac output than central venous saturation or indices based on venous-arterial O2 content difference. In our case report of nonseptic patients, we observed that if global hypoperfusion was present (i.e., in type A lactic acidosis), pCO2 gap was elevated (>1 kPa), whilst in the absence of it (i.e., in type B lactic acidosis), pCO2 gap was low (<0.5 kPa). Conclusion. Physiological rationale and a small case series are consistent with the hypothesis that low pCO2 gap in nonseptic critically ill is suggestive of the absence of tissue hypoperfusion, mandating the search for the cause of type B lactic acidosis rather than administration of fluids or other drugs aimed at increasing cardiac output.

Treatment of juxta-anastomotic stenoses for failing distal radiocephalic arteriovenous fistulas: Drug-coated balloons versus angioplasty

2018 ◽  
Vol 20 (2) ◽  
pp. 209-216 ◽  
Author(s):  
Domenico Patanè ◽  
Giovanni Failla ◽  
Giovanni Coniglio ◽  
Giorgio Russo ◽  
Walter Morale ◽  
...  
Keyword(s):  
Percutaneous Transluminal Angioplasty ◽  
Type A ◽  
Target Lesion ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Secondary Patency ◽  
Type B ◽  
Arteriovenous Fistulas ◽  
Percutaneous Transluminal ◽  
Drug Coated Balloon

The aim of our study is to report the results of two types (type A, type B) paclitaxel drug-coated balloon compared with standard percutaneous transluminal angioplasty in the treatment of juxta-anastomotic stenoses of mature but failing distal radiocephalic hemodialysis arteriovenous fistulas. Two groups of 26 and 44 patients treated with two different drug-coated balloon are compared with a control group of 86 treated with standard percutaneous transluminal angioplasty. A color Doppler ultrasound was performed to evaluate stenosis and for treatment planning. We assess primary patency, defined as the absence of dysfunction of the arteriovenous fistulas, patent lesion or residual stenosis < 30% and no need for further reintervention of target lesion. Primary patency and secondary patency are evaluated after 12 months with color Doppler ultrasound for the whole arteriovenous fistulas, defined as absolute (absolute primary patency, absolute secondary patency) and target lesion. Postprocedural technical and clinical success was 100%. After 12 months, absolute primary patency is 81.8% for type A, 84.1% type B, and 54.7% for standard percutaneous transluminal angioplasty; target lesion primary patency is 92% type A, 86.4% type B, and 62.8% standard percutaneous transluminal angioplasty; absolute secondary patency is 95.4% type A, 95.5% type B, and 80.7% standard percutaneous transluminal angioplasty; target lesion secondary patency is 100% type A, 97.7% type B, and 80.7% standard percutaneous transluminal angioplasty. All the patients treated with drug-coated balloon (type A + type B) have an absolute primary patency of 83.3%, a target lesion primary patency of 87.9%, an absolute secondary patency of 95.5%, and a target lesion secondary patency of 98.4%. Our study confirms that the use of drug-coated balloon, indiscriminately among different brands, improves primary patency with statistically significant difference in comparison with standard percutaneous transluminal angioplasty and decreases reintervention of target lesion in juxta-anastomotic stenoses of failing distal arteriovenous fistulas maintaining the radiocephalic fistula as long as possible.

scholarly journals Intracranial hemorrhage from dural arteriovenous fistulas: clinical features and outcome

2013 ◽  
Vol 34 (5) ◽  
pp. E15 ◽  
Author(s):  
David J. Daniels ◽  
Ananth K. Vellimana ◽  
Gregory J. Zipfel ◽  
Giuseppe Lanzino
Keyword(s):  
Clinical Features ◽  
Intracranial Hemorrhage ◽  
Case Series ◽  
Venous Drainage ◽  
Sudden Onset ◽  
Residual Symptoms ◽  
Arteriovenous Fistulas ◽  
Common Location ◽  
Dural Arteriovenous Fistulas

Object In this paper the authors' goal was to review the clinical features and outcome of patients with intracranial dural arteriovenous fistulas (DAVFs) who presented with hemorrhage. Methods A retrospective study of 28 patients with DAVFs who presented with intracranial hemorrhage to 2 separate institutions was performed. The information reviewed included clinical presentation, location and size of hemorrhage, angiographic features, treatment, and clinical and radiologically documented outcomes. Clinical and radiological follow-up were available in 27 of 28 patients (mean follow-up 17 months). Results The vast majority of patients were male (86%), and the most common presenting symptom was sudden-onset headache. All DAVFs had cortical venous drainage, and about one-third were associated with a venous varix. The most common location was tentorial (75%). Treatment ranged from endovascular (71%), surgical (43%), Gamma Knife surgery (4%), or a combination of modalities. The majority of fistulas (75%) were completely obliterated, and most patients experienced excellent clinical outcome (71%, modified Rankin Scale score of 0 or 1). There were no complications in this series. Conclusions Case series, including the current one, suggest that the vast majority of patients who present with intracranial hemorrhage from a DAVF are male. The most common location for DAVFs presenting with hemorrhage is tentorial. Excellent outcomes are achieved with individualized treatment, which includes various therapeutic strategies alone or in combination. Despite the hemorrhagic presentation, almost two-thirds of patients experience a full recovery with no or minimal residual symptoms.

scholarly journals Pregnancy outcomes following botulinum toxin type A exposure: A systematic review

2018 ◽  
Vol 6 (05) ◽  
Author(s):  
Noha Abdelkader ◽  
Elif Keskin Arslan ◽  
Hilal Erol- Coskun ◽  
Gözde Küçüksolak ◽  
Yusuf Cem Kaplan
Keyword(s):  
Botulinum Toxin ◽  
Pregnancy Outcomes ◽  
Congenital Malformations ◽  
Case Reports ◽  
Botulinum Toxin Type A ◽  
Case Series ◽  
Fetal Loss ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Major Congenital Malformations

Objective: To evaluate the available human data to-date in order to assess whether the prenatal exposure to botulinum toxin type A (BTX-A) is associated with major congenital malformations and other adverse pregnancy outcomes. Methods: Searches were conducted in PubMed/MEDLINE and Reprotox in November  2017. Cohort and case-control studies, case series, case reports were the primary data of interest. Results: No controlled studies but case series and case reports of therapeutic BTX-A administration during pregnancy were identified. Case reports regarding pregnant women with botulism were also reviewed. Conclusions: Limited data suggests that BTX-A exposure for therapeutic indications during pregnancy does not seem to be associated with an increase in risk of major congenital malformations. Rates of fetal loss were substantially different between prospective and retrospective data. Controlled epidemiological studies are needed to refute or support our findings.

Bidirectional Irrigation System to Treat a Difficult Wound: A Case Series

2020 ◽  
pp. 153473462097455
Author(s):  
Li-Yung Chen ◽  
Jin-De Hou ◽  
Chian-Ze Peng
Keyword(s):  
Healing Rate ◽  
Irrigation System ◽  
Recovery Period ◽  
Case Series ◽  
Type A ◽  
Type B ◽  
Wound Irrigation ◽  
Secondary Infections ◽  
Case Series Study ◽  
The Stability

Aims To date, there is no distinct principle determining whether to use irrigation under negative-pressure wound therapy (NPWT). We developed a new economical device to manage difficult wounds, employing 1 of 2 techniques depending on the wound condition. Methods This case series study was conducted in 12 patients with difficult wound, from 2017 to 2018. Four patients were treated with Type A bidirectional irrigation system (wound irrigation), while 8 patients were treated with Type B bidirectional irrigation system (wound irrigation combined with NPWT). Results In the Type A device group, inflammatory profiles in case I, case IV, and case VIII were not monitored due to the stability of their wound. The mean recovery period was 3.75 weeks (2-8 weeks), with decreases in 100% healing rate. In the Type B device group, we noted an average of 71% reduction in inflammatory profiles. All patients’ infections were resolved or were healing, and 7 patients recovered satisfactorily. The recovery period ranged from 4 to 17 weeks, with a median value of 7 weeks. Conclusion Bidirectional irrigation system decreases secondary infections and complications, and increases the healing rate in patients with difficult wound.

scholarly journals Selective Transvenous Embolization of Dural Arteriovenous Fistulas Involving the Hypoglossal Canal

2007 ◽  
Vol 13 (1) ◽  
pp. 59-66 ◽  
Author(s):  
M. Okahara ◽  
H. Kiyosue ◽  
S. Tanoue ◽  
Y. Sagara ◽  
Y. Hori ◽  
...  
Keyword(s):  
Jugular Vein ◽  
Critical Evaluation ◽  
Venous Drainage ◽  
Transvenous Embolization ◽  
Venous Plexus ◽  
Venous Anatomy ◽  
Hypoglossal Canal ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Posterior Condylar

The hypoglossal canal contains a venous plexus that connects the inferior petrous sinus, condylar vein, jugular vein and paravertebral plexus. The venous plexus is one of the venous drainage routes of the posterior skull base. Only a few cases of dural arteriovenous fistulas (AVFs) involving the hypoglossal canal have been reported. We describe three cases (a 62-year-old female, a 52-year-old male, and an 83-year-old male) of dural AVFs involving the hypoglossal canal. Symptoms were pulse-synchronous bruit in two cases and proptosis/chemosis in one. All dural AVFs were mainly fed by the ipsilateral ascending pharyngeal artery. Two of three dural AVFs involving the hypoglossal canal mainly drained through the anterior condylar confluence into the inferior petrosal sinus retrogradely with antegrade drainage through the lateral condylar vein. The other one drained through the lateral and posterior condylar veins into the suboccipital cavernous sinus. All dural AVFs were completely occluded by selective transvenous embolization without any complications, and the symptoms disappeared within one week in all cases. Dural AVFs involving the hypoglossal canal can be successfully treated by selective transvenous embolization with critical evaluation of venous anatomy in each case.

Concomitant conus medullaris arteriovenous shunts and sacral dural arteriovenous fistulas: pathophysiological links related to the venous drainage of the lesions in a series of five cases

2018 ◽  
Vol 10 (6) ◽  
pp. 586-592 ◽  
Author(s):  
Andrea Rosi ◽  
Arturo Consoli ◽  
Stéphanie Condette-Auliac ◽  
Oguzhan Coskun ◽  
Federico Di Maria ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Young Patients ◽  
Case Series ◽  
Venous Drainage ◽  
Conus Medullaris ◽  
Venous Hypertension ◽  
Arteriovenous Fistulas ◽  
Congenital Origin ◽  
Arteriovenous Shunts ◽  
Dural Arteriovenous Fistulas

BackgroundSpinal cord arteriovenous shunts (scAVSs) are a group of lesions located in the spinal cord itself or in the surrounding structures. The most common scAVSs are spinal dural arteriovenous fistulas (sDAVFs), which are acquired lesions. The pathogenesis of sDAVFs involves thrombosis and venous hypertension as trigger factors. Intradural scAVSs such as spinal cord arteriovenous nidus type malformations (AVMs) and pial arteriovenous fistulas are less common than sDAVFs and are considered to have a so-called ‘congenital’ origin. The association between different concomitant scAVSs is very rare and the association of sDAVFs with intradural scAVSs has been described in only a few case reports.MethodsWe describe a case series of five patients presenting with a conus medullaris AVS associated with a lower lumbar or sacral DAVF.ResultsThree of our patients were <30 years old at presentation. In four of these five cases the intradural scAVS drained caudally, engorging the epidural plexus in the same location as the sDAVF. In only one case, who presented with thrombosis of the drainage of the main compartment of a conus medullaris pial AVF, was the location of the DAVF opposite to the location of the residual drainage.ConclusionWe discuss the pathophysiological link between scAVS and sDAVF on the basis of the rarity of the DAVF, the uncommon association between scAVS and sDAVF, the presence of sDAVF in young patients, and the venous hypertension created by the venous drainage towards the sacral area responsible for angiogenesis creating the dural shunt.

Influence of the combination of patient age and deep venous drainage on brain arteriovenous malformation recurrence after surgery

2012 ◽  
Vol 117 (5) ◽  
pp. 934-941 ◽  
Author(s):  
Michael Kerin Morgan ◽  
Nirav J. Patel ◽  
Mary Simons ◽  
Elizabeth Anne Ritson ◽  
Gillian Z. Heller
Keyword(s):  
Cox Regression ◽  
Case Reports ◽  
Young Patients ◽  
Case Series ◽  
Venous Drainage ◽  
Age Group ◽  
Risk Of Recurrence ◽  
Kaplan Meier ◽  
Initial Surgery ◽  
Increased Risk

Object Case reports suggest that young age is a critical factor in determining recurrence of brain arteriovenous malformations (AVMs) after surgery. However, other factors that may contribute to the increased risk of recurrence have not been considered. In this study, the authors' goal was to ascertain the risk and risk factors of recurrence after resection of AVMs of the brain. Methods A consecutive case series (prospectively collected data) of 600 cases of resection of brain AVMs was retrospectively analyzed. Radiological evidence of recurrence or nonrecurrence, as well as clinical evidence of recurrence, could be established in 427 of these cases that underwent follow-up for more than 350 days after initial surgery. These cases were analyzed using Kaplan-Meier curves and Cox regression with respect to age and the presence of deep venous drainage. Results Nine recurrent AVMs were found in 8 patients. By analysis of the Kaplan-Meier curves, the 10-year recurrence rate was 14% for those with deep venous drainage, compared with 4% for those without deep venous drainage. Stratifying by age, in the 0- to 20-year age group, the 10-year recurrence rates were 63% and 13% for those with and without deep venous drainage, respectively. In the 20- to 39-year age group, the rates were 5% and 0% respectively, and in the 40-year and older age group they were 0% and 3%, respectively. The hazard ratio for deep venous drainage, adjusted for age, was 5.97 (95% CI 1.20–29.69, p = 0.029). Conclusions The risk of recurrence after AVM resection is significant for young patients with deep venous drainage.

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

2015 ◽  
Vol 8 (6) ◽  
pp. 643-647 ◽  
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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