Abstract
Spinal arteriovenous fistulas are challenging to cure by endovascular means, with a risk of incomplete occlusion or delayed recurrence. The authors report herein their preliminary experience using the pressure cooker technique for the embolization of spinal arteriovenous fistulas.Fifteen patients (8 men; mean age, 60.3 years) underwent an endovascular treatment of a spinal arteriovenous fistula (12 dural spinal arteriovenous fistulas and 3 epidural spinal arteriovenous fistulas) in 2 different institutions using the pressure cooker technique. Two microcatheters could be navigated in the segmental artery in all patients using 2 guiding catheters. A proximal plug was achieved with highly concentrated cyanoacrylate ± coils. The liquid embolic agent injected to cure the fistula was diluted cyanoacrylate (n = 11) or ethylene-vinyl alcohol (n = 4). Technical and clinical complications were systematically recorded. Clinical and angiographic outcomes were systematically evaluated at follow-up.One (6.7%) procedure-related complication was recorded, which consisted of a transient radicular deficit, related to nerve root ischemia. Clinical improvement was observed in 10/14 (71%) patients for whom clinical follow-up was available. Complete spinal arteriovenous fistula occlusion on a follow-up angiography was observed in 11/12 patients (91.7%) for whom angiographic follow-up was available. One patient (8.3%) presented with a delayed recurrence at 29 months.The pressure cooker technique is feasible, with either glue or ethylene-vinyl alcohol, for the embolization of spinal arteriovenous fistulas. Our results suggest the safety and effectiveness of this technique.
Highlights
Our results suggest the safety and effectiveness of this technique
Spinal arteriovenous fistulas (SAVFs) are rare vascular malformations involving the spinal cord and corresponding to an abnormal arteriovenous (AV) shunt between spinal dural arteries and the radicular vein or the epidural venous plexus, which “contaminates” secondarily the spinal venous drainage. 1 2 Most of these SAVFs are clinically revealed by a venous congestion, responsible for progressive sensory and/or motor deficits of the inferior limbs, often associated with sphincter disturbance (i.e.: urinary/fecal incontinence, sexual impotence)
5 The pressure cooker technique (PCT) has been developed to improve the penetration of liquid embolic agents in the embolization of brain arteriovenous malformations (AVMs), increasing the occlusion rate in endovascular treatment of brain AVMs. 6 The purpose of our study was to report our experience of the PCT for the endovascular treatment of SAVF
Summary
Spinal arteriovenous fistulas (SAVFs) are rare vascular malformations involving the spinal cord and corresponding to an abnormal arteriovenous (AV) shunt between spinal dural arteries and the radicular vein or the epidural venous plexus, which “contaminates” secondarily the spinal venous drainage. 1 2 Most of these SAVFs are clinically revealed by a venous congestion, responsible for progressive sensory and/or motor deficits of the inferior limbs, often associated with sphincter disturbance (i.e.: urinary/fecal incontinence, sexual impotence). 3 The best treatment option for SAVFs is still a matter of debate since no randomized controlled trial has compared endovascular treatment and surgery. 4 Even if being minimally-invasive, the main drawback of the endovascular treatment is the risk of incomplete occlusion of the shunt point, which may lead to treatment failure or recurrence. 5 The pressure cooker technique (PCT) has been developed to improve the penetration of liquid embolic agents in the embolization of brain arteriovenous malformations (AVMs), increasing the occlusion rate in endovascular treatment of brain AVMs. 6 The purpose of our study was to report our experience of the PCT for the endovascular treatment of SAVF. Even if being minimally-invasive, the main drawback of the endovascular treatment is the risk of incomplete occlusion of the shunt point, which may lead to treatment failure or recurrence. The pressure cooker technique (PCT) has been developed to improve the penetration of liquid embolic agents in the embolization of brain arteriovenous malformations (AVMs), increasing the occlusion rate in endovascular treatment of brain AVMs. 6 The purpose of our study was to report our experience of the PCT for the endovascular treatment of SAVF. Spinal arteriovenous fistulas (SAVFs) are challenging to cure by endovascular means, with a significant risk of incomplete occlusion or delayed recurrence. The authors report their preliminary experience using the pressure cooker technique (PCT) for the embolization of SAVFs
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