Arteriovenous Fistula Research Articles

Sural‐to‐medial femoral cutaneous amplitude ratio in early diagnosis of uremic neuropathy

AbstractIntroductionMedial femoral cutaneous (MFC) sensory nerve action potentials (SNAPs) can be easily recorded using distal stimulation. This study aimed to identify a new parameter using MFC SNAPs for the early electrophysiological diagnosis of length‐dependent axonal polyneuropathy (LDAP) associated with uremic neuropathy.MethodsPatients with chronic renal failure who were referred to the electrodiagnostic laboratory due to symptoms suggesting polyneuropathy were included. Assessments encompassed neurological examination, Michigan Neuropathy Screening Instrument (MNSI), and Semmes–Weinstein monofilament test. Antidromic radial, median, ulnar, MFC, sural, and superficial peroneal sensory; median, ulnar, tibial, and peroneal motor nerve conduction studies were performed. Sural‐to‐radial amplitude ratio (SRAR) and sural‐to‐medial femoral cutaneous amplitude ratio (SMFCAR) were calculated, and their diagnostic sensitivities were compared with the age and sex matched healthy controls.ResultsThirty‐two chronic renal failure patients (mean age 60.0 ± 9.6 years) and 37 controls (60.6 ± 9 years) were included. MNSI indicated clinical polyneuropathy in 59.4% of patients, while sural SNAP amplitude was diagnostic in 78%. Median SRAR and SMFCAR values were significantly lower in patients than controls (p < .001 for both). The cut‐off values for SMFCAR and SRAR were <1.82 and <0.30, respectively, both with a sensitivity of 59% and a specificity of 94%.DiscussionSural SNAP is the most sensitive parameter in the diagnosis of LDAP. SMFCAR is not superior to SRAR. If the sural SNAP amplitude is normal, SMFCAR can serve as an alternative to SRAR in dialysis patients with bilateral arteriovenous fistulae or in those unable to undergo radial NCS.

The price of dialysis access: Implications of access type and patient-centric approaches to cost

Purpose: This study explores out-of-pocket (OOP) costs for patients and provider reimbursement for dialysis access creation. It aims to illustrate the financial characteristics of four dialysis access modalities to consider in decision-making for clinicians, patients, and payers. Materials and methods: Retrospective data from the Merative™ MarketScan Commercial Claims and Encounters Databases from 2017 to 2022 was analyzed for patients who received an arteriovenous fistula (AVF), arteriovenous graft (AVG), peritoneal dialysis catheter (PDC), or percutaneous AVF (pAVF). ANOVA and Tukey HSD were used to assess cost differences among the four access modalities overall and in the context of insurance type and service site. Results: Database extraction resulted in 20,863 unique procedures, comprising of 15,043 AVF, 4759 AVG, 896 PDC, and 165 pAVF. Mean age was 59.2 years (±14.19) and 60.53% of the cohort was male. EPO/PPO plans were the most represented (53.06%) and most procedures were performed in the hospital outpatient department (91.99%). There were significant differences found among OOP cost and reimbursement with respect to procedure type, insurance type, and service site. Overall, pAVF had both the highest cost and reimbursement. Conclusion: Patient OOP costs and provider reimbursement differ significantly based on procedure, insurance type, and service site. While pAVF creation is recognized with high reimbursements due to its complexity and the advanced technology required, it also has the highest OOP costs for patients. To help facilitate adoption of new technologies like pAVF, advocacy efforts should focus on encouraging payers to lower the OOP financial barriers for patients to receive these newer but costlier procedures.

Early and Midterm Outcomes of Percutaneous Arteriovenous Fistula Creation

Early and Midterm Outcomes of Percutaneous Arteriovenous Fistula Creation

Poor mid-term functional patency and post-operative outcomes in diabetic patients who undergo arteriovenous graft creation

Introduction: Diabetes mellitus is a leading cause of renal failure in the US and has been associated with higher mortality when compared to nondiabetic patients. This remains true despite initiation of renal replacement therapy. As such, we were interested in identifying any potential differences in access durability and postoperative outcomes in diabetic patients who receive arteriovenous fistulas versus grafts for hemodialysis. Methods: Diabetic patients undergoing their first arteriovenous (AV) access creation surgery in the Vascular Quality Initiative from January 2011 to January 2022 were included in our study. After exclusions, the study included two groups: those receiving AV fistulas and those receiving AV grafts for hemodialysis. Demographic characteristics were summarized and compared between these two groups using chi-square analysis or unpaired t-test. After propensity score matching was conducted, the effect of procedure type on functional patency, along with secondary outcomes including wound infection were assessed using chi-square analysis. Results: A total of 20,159 diabetic patients who used their hemodialysis access were included in our study; 16,205 received AV fistulas while 3954 received AV grafts. Patients receiving AV grafts were more likely to be older, female, and have higher pre-operative catheter usage. After propensity score matching, patients who received AV grafts had a shorter time-to-use their conduit (50 vs 166 days, p < 0.0001), however, patients who received AV fistulas were more likely to have longer functional patency use for hemodialysis when compared to those who received AV grafts (mean survival time: 3.3 vs 2.9 years, p < 0.0001). These results were consistent between diabetics with insulin-dependent or insulin-independent diabetes. Conclusion: Patients diagnosed with diabetes mellitus had an increased risk for significantly inferior clinical outcomes related to newly created AV grafts, including lower rates of mid-term functional patency and higher rates of worse post-operative outcomes when compared to diabetics who received AV fistulas.

Mineralocorticoid receptor antagonism attenuates arteriovenous fistula stenosis by modulating the phenotype of vascular smooth muscle cells

Mineralocorticoid receptor antagonism attenuates arteriovenous fistula stenosis by modulating the phenotype of vascular smooth muscle cells

Safety and efficacy of an innovative external support device for de novo arterio-venous fistula creation: a French bicentric experience.

The aim of this study was to evaluate the safety and efficacy of VasQTM, a permanent extravascular nitinol vascular support device, implanted around the anastomosis of de novo arteriovenous fistulas (AVF), in consecutive patients. This was a French prospective bicentric study. All patients with an indication for creation of a distal or proximal end to side AVF performed by supervised trainee were eligible. Follow-up was performed clinically and by Duplex scan at 6 weeks and 6 months post fistula creation. Primary endpoint was functional maturation at 6 weeks defined as successful use for dialysis via 2-needle cannulation in dialysis patients or a flow rate of ≥600 mL/min and a target vein diameter ≥6 mm for pre-dialysis patients. Overall functional success for dialysis patients was assessed as well. Between March and November 2022, 21 patients received the VasQTM device and were followed for an average of 165 days. Median age was 61. Eleven patients (52%) were on dialysis at the time of implantation. AVFs were created with distal radial (N.=8), proximal radial (N.=5), brachial cephalic (N.=4) or brachial basilic (N.=4) arteries with 100% technical success . Functional maturation at 6-weeks was achieved in 81% (17/21). Functional success was 80% (12/15) with unassisted functional success of 67% (10/15) at 6 months for patients requiring dialysis at that time point. Two reoperations were performed within the device, one thrombectomy and one angioplasty, both were successful. Freedom from access-related interventions occurred in 71% (15/21) of the study population at 6-months. This study demonstrates that the VasQTM AVFs achieved high rates of maturation at 6-weeks, without the need to modify standards of care. VasQTM can successfully assist in achieving excellent results at the introduction of the device to a new center.

Risk factors for puncture-related complications after cerebrovascular angiography and neuroendovascular intervention with distal transradial approach

Background and purposeTo determine the risk factors for puncture-related complications after the distal transradial approach (dTRA) for cerebrovascular angiography and neuroendovascular intervention and to explore the incidence and potential mechanisms of procedural failure and puncture-related complications.Materials and methodsFrom February to November 2023, 62 patients underwent dTRA in our department. Demographic, clinical, and procedural data were collected retrospectively. Postoperative puncture-related complications were defined as a syndrome of major hematoma, minor hematoma, arterial spasm/occlusion, arteriovenous fistula, pseudoaneurysm, and neuropathy. Univariate and multivariate logistic regressions were performed to identify significant factors contributing to puncture-related complications.ResultsForty-five diagnostic cerebral angiograms and 17 neurointerventions were performed or attempted with dTRA in 62 patients. Procedural success was achieved via dTRA in 47 (75.8%) patients, whereas 15 (24.2%) required conversion to other approaches. Reasons for failure included puncture failure (n = 8), inability to cannulate due to arterial spasm (n = 6), and inadequate catheter support of the left vertebral artery (n = 1). 17.0% (8/47) of patients had postoperative puncture-related complications. Minor hematoma occurred in 8.5% (4/47) of patients, arterial spasm/occlusion in 6.3% (3/47), and neuropathy in 2.1% (1/47). No major complications were observed. On stepwise multivariable regression analysis, BMI (OR = 0.70, 95%CI 0.513 to 0.958; p = 0.026) was an independent risk factor for puncture-related complications, with a cut-off of 24.8 kg/m2 (sensitivity 66.7% and specificity 87.5%).ConclusionOur cohort is the first study of risk factors for puncture-related complications after neurointerventional interventions with dTRA. This study has shown that a low BMI (< 24.8 kg/m2) is independently associated with the development of puncture-related complications.

A resident’s sharp learning curve: Post-needle stick injury arteriovenous fistula of the finger

Iatrogenic vascular injuries can be encountered during diagnostic or therapeutic interventions. Traumatic arteriovenous fistulas (AVFs) occur due to penetrating injury involving contiguous arteries and veins. We report a case of a 27-year-old postgraduate trainee who presented with swelling over her left middle finger for 5 months following a needle prick injury at the same site 1 year back, which was diagnosed with ultrasound and dynamic magnetic resonance imaging angiography. Endovascular embolization is avoided in AVFs of the hand due to the risk of distal ischemia, and surgical excision with reconstruction is the preferred treatment.

Utility of the turn-back supporting technique using a steerable intermediate catheter: illustrative case.

Selective shunt occlusion (SSO) for intracranial dural arteriovenous fistulas (DAVFs) is a safe and effective method that directly intercepts the shunted pouch from the affected sinus with minimal materials. However, it can be challenging to obliterate the shunted pouch if the microcatheter is not supported adequately. A 68-year-old woman presented with tinnitus and was diagnosed with multiple shunted DAVFs in the right transverse-sigmoid sinus (TSS) and the superior sagittal sinus (SSS). Although the entire sinus packing of the right TSS was performed, a follow-up angiography 7 months later revealed significant cerebral venous reflux due to occlusion of the left TSS and an increasing residual shunt flow in the venous pouch at the confluence of the SSS. A guiding catheter was introduced into the isolated sinus transvenously. Then, a steerable intermediate catheter (SIC) was manually steered into a hairpin shape and hooked on near the pouch prior to navigating a microcatheter into the fistula point. Finally, the fistula pouch was completely obliterated using only two coils under the adequate support of the turned-back intermediate catheter. The turn-back supporting technique using an SIC was useful in achieving SSO for DAVFs, providing both adequate support and guidance for the coaxial microcatheter. https://thejns.org/doi/10.3171/CASE24467.

Brainstem hemorrhage associated with venous hypertensive myelopathy without dural arteriovenous fistula: illustrative case.

Venous hypertensive myelopathy (VHM), formerly known as "Foix-Alajouanine syndrome," is a spinal cord dysfunction caused by impaired perfusion of the spinal cord. Most cases are attributed to spinal dural arteriovenous fistulas (dAVFs), but there are scattered reports of VHM without concomitant dAVF. Furthermore, no cases of VHM associated with intracranial hemorrhage exist. A 68-year-old man with a history of hypertension presented with a sudden headache, proximal paresis of the left upper extremity, impaired pain and temperature sensation in the right upper extremity, dysphagia, and dysarthria. Computed tomography scans showed intraparenchymal hemorrhage in the left medulla oblongata and a linear, continuous high-density area extending from the medulla oblongata to the cervical spinal cord. Magnetic resonance images showed cervical spondylosis at the C5-6 and C6-7 levels, with high signal intensity changes from the medulla oblongata to the lower cervical cord on T2-weighted images. Cerebral angiography showed no abnormal vessels. Conservative treatment gradually improved symptoms and the high signal intensity areas. This case highlights intracranial hemorrhage occurring from extracranial causes and the possibility of VHM due to cervical spondylosis. When hemorrhagic lesions of the craniovertebral junction or spinal parenchymal lesions are encountered, the underlying pathology should be investigated thoroughly and systematically. https://thejns.org/doi/10.3171/CASE24441.

Coronary arteriovenous fistula originating from the left coronary artery and draining into the superior vena cava.

Coronary arteriovenous fistulas are rare coronary anomalies. Most fistulas arise from the right coronary artery and drain into the right heart structures. We report a case of a 59-year-old man with a rare coronary arteriovenous fistula that originates from the left coronary artery and drains into the superior vena cava. He was diagnosed incidentally with cardiac computed tomography during the investigation for atrial fibrillation. Surgical fistula ligation was successfully performed under cardiac arrest with cardiopulmonary bypass. The patient was discharged without complications.

The Potential of Sound Analysis to Reveal Hemodynamic Conditions of Arteriovenous Fistulae for Hemodialysis.

Arteriovenous fistula (AVF), the preferred vascular access for hemodialysis, is associated with high failure rate. The aim of this study was to investigate the potential of AVF sound auscultation in providing quantitative information on AVF hemodynamic conditions. This single-center prospective study involved six patients with native radio-cephalic AVFs who underwent multiple follow-up visits. Doppler Ultrasound blood flow volume (BFV) assessment and electronic stethoscope-based sound recordings were performed during each visit, whereas MRIs were acquired 3days, 3weeks and 1year after surgery. Computational fluid dynamic (CFD) simulations were performed on patient-specific MRI-derived geometrical models. Higher values of median peak amplitudes ratios (high-low peak ratio-HLPR) were found to be associated with complex blood flow and velocity streamlines recirculation at systolic peak, and corresponding extended regions of high oscillatory shear index (OSI). On the contrary, lower values of HLPR were associated with laminar flow pattern and low values of OSI. Significant differences were observed in HLPR between subgroups with extended or limited areas with OSI > 0.1 (0.67 vs 0.31, respectively). Significant relationships were found between AVF sound intensity and brachial BFV (slope = 0.103, p < 0.01) as well as between longitudinal changes in brachial BFV and HLPR (slope = - 0.001, p < 0.01). Our results show that AVF sound can be exploited to extract fundamental information on AVF hemodynamic conditions, providing indication of the presence of complex hemodynamic and adequate BFV to perform hemodialysis. Sound analysis has therefore the potential to improve clinical AVF surveillanceand to ameliorate outcome.

Validity and Reliability of the Persian Version of the Scale of the Assessment of Self-Care Behaviors With Arteriovenous Fistula in Patients on Hemodialysis.

Background and Purpose: This methodological study aimed to assess the psychometric properties of the Persian version of the scale for evaluating self-care behaviors with arteriovenous fistula. Methods: This cross-sectional study with a methodological design was planned and conducted in 2022. The Scale of the Assessment of Self-Care Behaviors with Arteriovenous Fistula was translated into Persian. Subsequently, the validity (content and construct) and reliability of this scale were assessed. Results: The exploratory factor analysis revealed a two-factor structure for the scale, accounting for 60.71% of the total variance. Confirmatory factor analysis results indicated that all goodness-of-fit indices supported the model fit (χ2/df = 1.925, Goodness-of-Fit Index = .903, Normed Fit Index = 0.933, Incremental Fit Index = 0.950, Comparative of Fit Index = .950, and Root Mean Square Error of Approximation = .047). Furthermore, this study found that both factors demonstrated satisfactory levels of convergent and divergent validity (construct reliability = .934 and .885 for factors 1 and 2, respectively). After careful evaluation, all coefficients of internal consistency were deemed acceptable (α = .872 and McDonald's omega = 0.879). Conclusions: These significant findings provide compelling evidence that this scale can effectively assess patients' self-care behaviors and facilitate the provision of necessary training in this domain.

Infratemporal Arteriovenous Fistula Presenting with Peripheral Facial Palsy

Peripheral facial palsy results from facial nerve injury. While most cases are idiopathic (Bell's palsy) with favorable prognosis, other causes such as trauma, infection, and compression have poor outcomes. An arteriovenous fistula (AVF) is a direct connection between an artery and a vein that is treatable with endovascular procedures, making early diagnosis essential. We report a case of a 68-year-old woman with peripheral facial palsy and pulsatile pain for four months, diagnosed with an infratemporal AVF compressing the facial nerve.

Transarterial embolization of petrosal dural arteriovenous fistula (dAVF): Feasible and successful in the post-Onyx era

Background: Intracranial dural arteriovenous fistula (dAVF) is a rare arteriovenous malformation with potentially severe complications. This study investigates the efficacy and safety of transarterial embolization (TAE) in treating petrous dAVFs through a retrospective analysis and literature review. Case Description: A retrospective analysis of six patients with petrous dAVFs treated with TAE was conducted, accompanied by a systematic literature review to evaluate treatment outcomes. Data collection included patient characteristics, clinical presentation, Borden–Shucart and Cognard classifications, treatment specifics, and overall outcomes. TAE, particularly utilizing Onyx, demonstrated favorable outcomes in our six patients. Regarding literature review results, 102 articles were identified through PubMed Mesh tool search, but only five were included after careful evaluation. In addition, one article was manually added after searching for the remaining articles. Combining our six cases with literature findings, 79.8% (n = 75) of patients undergoing TAE achieved a cure with the technique, though Onyx was reported in only 13.9% (n = 13) of TAE cases. Complications were observed in 11.7% (n = 11) of TAE cases. Conclusion: Our presented cases and literature review suggest that the TAE of dAVFs is feasible and curative for selected cases of petrous dAVFs. However, the complexity of these lesions and the availability of other treatment modalities should be taken into consideration to optimize cure rates and patient outcomes.

Foix–Alajouanine syndrome: a comprehensive overview of rare but relevant diagnosis

Introduction: Foix–Alajouanine syndrome (FAS) is an uncommon neurological disorder marked by the gradual development of spinal cord congestion. First documented by Foix and Alajouanine in 1926. Although it is infrequent, delayed or misdiagnosis is nonetheless prevalent, resulting in inadequate therapy and unfavorable results. Methods: Using the PubMed database, MEDLINE, and EMBASE, we collected data on FAS patients and conducted a pooled analysis. The term ‘FAS’ was used to search for related articles. Our search was restricted to previous clinical case reports or series that were published in English. Non-English articles were excluded. We included the articles in the period from 1974 to 2024. Articles were eligible if the radiographic and clinical findings were indicative of FAS. A thorough research analysis was performed, examining case reports that specifically addressed this issue. This study examines the clinical symptoms, difficulties in diagnosis, methods of treatment, and outcomes related to FAS. Results: FAS predominantly impacts the elderly population. A total of 26 patients were diagnosed with FAS. The median age of affected individuals was 53 (SD ±15.96). The ratio of males to females is roughly 5:1. The clinical manifestations encompass gradual muscle weakness and sensory impairments. The diagnosis is dependent on radiological evaluations, specifically MRI and digital subtraction angiography. Possible treatments include endovascular therapy, surgical closure of arteriovenous fistula, or a combination of the two. Significant improvements in neurological impairments can be achieved by early intervention. Conclusion: The diagnosis of FAS continues to be difficult due to its infrequency and varied clinical manifestations. Prompt and precise diagnosis is essential for proper intervention, typically utilizing endovascular or surgical methods. Additional research is required to determine prognostic markers and enhance long-term care techniques for this rare neurological condition.

The Use of Pedicular Arteriovenous Fistula (PAVF) in Microvascular Reconstruction to Enhance Flow Across the Microvascular Anastomoses.

Free flap success rates have improved dramatically over the past three decades, setting a high standard for microvascular reconstruction. However, rates of arterial or venous thrombosis, and subsequent failure, remain high in burn and trauma reconstruction when compared to autologous breast reconstruction and other elective flaps. To address the higher failure rate, we use a novel vascular approach. We create a pedicular arteriovenous fistula (PAVF), allowing the flow to be enhanced across the microvascular anastomoses. We performed a retrospective review of 13 consecutive patients with 14 free flaps who underwent PAVF creation by the first author, AO. All patients who required free tissue transfer for trauma and burn reconstruction were indicated for PAVF during this study period. The flaps in this study included ALT, fibula, parascapular, and partial latissimus. The perforator and pedicle for the flaps were dissected in the usual manner. Distal to the takeoff of the perforator to the flap, the pedicular artery and the larger of the accompanying veins were anastomosed to create the PAVF. Patients were followed for a mean of 171 days Thrombosis was a rare complication in the group with one venous thrombosis (n = 1, 7.14%) and no arterial thrombosis. The most common complication was return to the operating room n = 4 (28.57%), two of which secondary to hematomas (14.29%), one wound dehiscence and one venous thrombosis. This latter patient eventually had partial flap loss. We did not observe flap ischemia due to vascular steal, nor any venous congestion from pressurizing the venous outflow. As opposed to anticoagulation, flow enhancement aims to decrease the risk of thrombosis by reducing stasis. While further data is needed to compare the outcomes of venous enhanced flaps when compared to flaps treated prophylactically with anticoagulation, our initial data suggests that PAVF is a safe procedure and does not result in vascular steal or flap congestion.

Early postoperative resistance index can predict radiocephalic arteriovenous fistula failure.

Ultrasonography is valuable for assessing arteriovenous fistula (AVF) maturation. Brachial artery flow volume (FV) measured at 6 weeks post-AVF creation can predict AVF failure. However, the association between early postoperative FV and AVF failure remains unclear. The resistance index (RI) may also serve as a prognostic factor for AVF maturation; however, it has not been extensively studied. Therefore, we aimed to investigate the relationship between AVF failure and early postoperative FV and RI. We retrospectively analyzed data from 102 patients (mean age, 67.8 ± 14.2 years; male, 68.6%; diabetes mellitus, 52.0%) who underwent new radiocephalic-AVF creation between January 2019 and December 2023 in Japan. An ultrasound device was used to measure brachial artery FV and RI on postoperative days 0 and 1. AVF failure was defined as occlusion or stenosis requiring vascular access intervention or surgical revision before the first cannulation, or cannulation difficulty or FV dysfunction requiring vascular access intervention or surgery at the first cannulation. On postoperative day 0, FV was 383.1 ± 146.8 mL/min, and RI was 0.65 ± 0.11. On postoperative day 1, FV was 466.9 ± 179.2 mL/min, and RI was 0.62 ± 0.11. FV significantly increased, and RI was significantly reduced on postoperative day 1 compared to those on day 0 (p < 0.01). Multivariate analyses revealed that higher RI (per 0.1; odds ratio (OR), 2.16; 95% confidence interval (CI), 1.22-3.82), but not FV, was significantly associated with AVF failure on postoperative day 0. On postoperative day 1, lower FV (per 100 mL/min; OR, 0.63; 95% CI, 0.42-0.95) and higher RI (per 0.1; OR, 2.17; 95% CI, 1.16-4.05) were significantly associated with AVF failure. This study highlights RI as a predictor of AVF failure in the early postoperative period when vasospasm is likely to occur.

Paclitaxel- or sirolimus-coated balloons used for ArterioVEnous fistulas-2 (PAVE-2): study protocol for a randomised controlled trial to determine the efficacy of paclitaxel- or sirolimus-coated balloons in arteriovenous fistulas used for haemodialysis

BackgroundIn view of the conflicting results from previous studies, the benefit of paclitaxel-coated balloons for arteriovenous fistulas is uncertain and equipoise remains. Although an industry-led trial testing the efficacy of sirolimus-coated balloons in AVFs is in progress, the benefit of sirolimus-coated balloons for arteriovenous fistulas is currently unknown. The purpose of this trial is to compare the efficacy of additional paclitaxel-coated or sirolimus-coated balloons on outcomes after a plain balloon fistuloplasty to preserve the patency of arteriovenous fistulae used for haemodialysis.MethodsThe study design is a multicentre randomised controlled trial. Following a successful plain balloon fistuloplasty, participants will be randomised to further treatment with a paclitaxel-coated balloon, a sirolimus-coated balloon, or an uncoated control balloon. We will recruit 642 patients, each with one or two treatment segments, over a 3-year period. Patients will remain in the trial and be followed up for 1 year. The primary endpoint is time to loss of treatment segment primary patency. Cox-proportional hazards models will be used to estimate hazard ratios for the time to loss of treatment segment primary patency for each treatment group relative to the control group. Analysis of the primary endpoint will be based on treatment segments rather than participants and a shared frailty will be estimated to account for the clustering of treatment segments within patients. Secondary endpoints are time to loss of primary patency at any treatment segment; time to end of access circuit primary patency; time to AVF abandonment; number of radiological or surgical interventions; adverse events; intima-media thickness and degree of stenosis at 3 months on ultrasound; and patient quality of life assessed by EQ-5D-5L and VASQoL.DiscussionThe three-armed design in this proposal will provide an answer on the efficacy of both paclitaxel- and sirolimus-coated balloons in the same trial. This trial is likely to provide a clear answer regarding the efficacy of drug-coated balloons for arteriovenous fistulas.Trial registrationISRCTN ISRCTN40182296. Registered on 4 August 2023.

Magnetic resonance imaging changes in spinal arteriovenous fistulae treated by endovascular means: are they reliable to predict complete cure of the fistula?

Regression or disappearance of MRI abnormalities is usually observed after treatment of spinal dural arteriovenous fistulae (sDAVF). To assess the correlation between spinal MRI (sMRI) changes with sDAVF exclusion and clinical outcome. Imaging data of patients treated with endovascular embolization for sDAVF between 2007 and 2023 were retrospectively analyzed. Spinal cord edema and perimedullary flow voids at baseline and 3-months' follow-up were compared between patients with and without sDAVF persistent occlusion and clinical improvement on the Aminoff and Logue Scale. Twenty-five patients were included in this study. At 3-months' follow-up, regression of spinal cord edema was significantly associated with sDAVF persistent occlusion (P=0.038). The combination of edema and flow voids regression was significantly associated with higher odds of a cured sDAVF (P<0.001) and clinical improvement (P<0.01). Improvement in the combination of the above-mentioned sMRI signs presented high sensitivity (100% (95% CI 78.20%-100%)) and negative predictive value (100% (95% CI 47.82%-100%)) for the detection of sDAVF cure compared with the criterion standard (digital subtraction angiography (DSA)). Patients with both spinal cord edema and flow voids regression at 3 months were more likely to present with a persistent occlusion of sDAVF and clinical improvement after endovascular embolization. Patients without sMRI improvement should be referred for DSA to seek recurrence of sDAVF.