Paraspinal Arteriovenous Fistula Research Articles

Paraspinal arteriovenous fistula: Stuttgart classification based on experience and a review of the literature.

The term "paraspinal arteriovenous shunts" (PAVSs) summarizes an inhomogeneous variety of rare vascular disorders. PAVSs have been observed as congenital or acquired lesions. The clinical course of PAVSs may be asymptomatic or present with life-threatening symptoms. Based on a collection of individual cases from three institutions and a literature evaluation, we propose the following classification: PAVSs that are part of a genetic syndrome are separated from "isolated" PAVSs. Isolated PAVSs are subdivided into "acquired", "traumatic" and "congenital" without an identifiable genetic hereditary disorder. The subgroups are differentiated by the route of venous drainage, being exclusively extraspinal or involving intraspinal veins. PAVSs associated to a genetic syndrome may either have a metameric link or occur together with a systemic genetic disorder. Again extra-vs intraspinal venous drainage is differentiated. The indication for treatment is based on individual circumstances (e.g. myelon compression, vascular bruit, high volume output cardiac failure). Most PAVSs can be treated by endovascular means using detachable coils, liquid embolic agents or stents and derivates.

A case of paraspinal arteriovenous fistula in the lumbar spinal body assessed with time resolved three‐dimensional phase contrast MRI

A 93-year-old female with a paraspinal arteriovenous fistula (AVF) occurred within the lumbar spinal vertebral body was assessed with time resolved three-dimensional (3D) phase-contrast MRI (4D-Flow) on 1.5 Tesla MR scanner (GE Healthcare). The 3D vector field, streamlines, and pathlines analyses demonstrated uni-directional flow from the aorta to the large vascular cavity in the lumbar vertebral body by means of the lumbar artery as well as dilated paravertebral veins as drainers, which confirmed AVF, not aortic pseudoaneurysm. The 4D-Flow also showed an added value in planned endovascular surgery concerning localization of the precise shunting point and the shunting volume quantification.

Paraspinal Arteriovenous Fistula Presenting With Subarachnoid Hemorrhage and Acute Progressive Myelopathy -Case Report-

A 60-year-old man presented with paraspinal arteriovenous fistula (AVF) manifesting as subarachnoid hemorrhage (SAH) and acute progressive myelopathy. The patient presented with sudden onset of low back pain and paraparesis. Spinal magnetic resonance imaging revealed a vascular malformation on the lumbar spinal canal. Three-dimensional computed tomography angiography demonstrated a paraspinal AVF in the sacral ventral pelvis. The clinical symptoms were progressing rapidly, so transarterial embolization and surgical drainage ligation were performed. Paraspinal AVF may present with SAH and cause acute progressive myelopathy. Prompt examination and treatment are necessary.

Transarterial and transvenous embolization of a paraspinal arteriovenous fistula

We report a rare case of a paraspinal arteriovenous fistula which was caused by a traumatic compression fracture. A 62-year-old man was admitted because of intermittent claudication, urinary dysfunction, and lumbago. Spinal magnetic resonance imaging and angiography revealed an epidural arteriovenous fistula at the T12 level which had multiple feeding arteries. A combination of transarterial and transvenous embolization achieved stable clinical improvement.

Congenital paravertebral arteriovenous fistula: A case report

Congenital paraspinal arteriovenous fistulae are rare and usually diagnosed after neurologic or cardiovascular manifestations. They may be discovered unexpectedly in children during clinical examination, which reveals the presence of a vascular murmur. The association with multicystic kidney is exceptional. We report 1 case with thoracic localization of a congenital paraspinal arteriovenous fistula associated with a multicystic kidney in a 3-year-old boy who was treated by endovascular embolization.

Lhermitte-Duclos Disease With Cervical Paraspinal Arteriovenous Fistula-Case Report-

A 38-year-old man presented with a dysplastic cerebellar gangliocytoma associated with a paraspinal arteriovenous fistula (AVF) at the upper cervical portion. Neuroimaging examination indicated the diagnosis of Lhermitte-Duclos disease. The patient was treated by embolization of the AVF followed by partial resection of the cerebellar tumor. Genetic examination showed a mutation of the phosphatase and tensin homolog deleted on chromosome ten (PTEN) gene. Histological examination confirmed the diagnosis. Lhermitte-Duclos disease is a rare dysplastic gangliocytoma manifesting as a slowly growing mass in the cerebellum and is usually asymptomatic. This case of Lhermitte-Duclos disease associated with paraspinal AVF and mutation of the PTEN gene suggests a relationship between Lhermitte-Duclos disease and Cowden disease.

Pediatric Thoraco-Lumbar Paraspinal Arteriovenous Fistulas along the Segmental Nerve

To characterize the clinical presentation, imaging features and endovascular treatment of paraspinal non-vertebral arteriovenous fistulas along the segmental nerve. Retrospective review was performed on the five patients identified in our database covering 1985 to 2003. All patients presented with an incidentally found continuous murmur over the upper paraspinal or parasternal regions before three years old. In four patients, the AV fistula was in the mid-thoracic level and at L3 in one. All AV fistulas were a high-flow single-hole fistula at the neural foramen with venous drainage into paraspinal and epidural veins without intradural reflux. All fistulas were endovascularly occluded in the same session as the diagnostic angiography. The fistula was occluded with detachable coils in one case and with N-butylcyanoacrylate (NBCA) with flow control in four cases. Complete occlusion of the fistula was obtained in all cases and all patients remained neurologically intact at the last follow up (average six years). Non-vertebral paraspinal arteriovenous fistula along the segmental nerve is a specific disease entity seen in children. Embolization is the first choice of treatment for this disease.

Pediatric nonvertebral paraspinal arteriovenous fistulas along the segmental nerve: clinical, imaging, and therapeutic considerations

The authors characterize the clinical presentation and imaging features of paraspinal nonvertebral arteriovenous fistulas (AVFs) along the segmental nerve and describe their endovascular treatment. The authors undertook a retrospective review of medical records, imaging, and treatment of patients with endovascular problems spanning the period from 1985 to 2003. Five pediatric patients (2-3 years of age) received diagnoses of nonvertebral paraspinal AVFs along the segmental nerve. All patients presented with an incidentally discovered continuous murmur over the paraspinal or parasternal regions. All patients were neurologically intact; two patients had cardiomegaly. The AVF was found in the midthoracic level in four patients and at L-3 in one patient. All AVFs were high-flow single-hole fistulas at the neural foramen with venous drainage into paraspinal and epidural veins but without intradural reflux. All fistulas were endovascularly occluded in the same session as diagnostic angiography took place. The fistula was completely occluded, with detachable coils in one case and with N-butyl-cyanoacrylate (NBCA) in four cases. Before NBCA injection, the flow through the fistula was decreased either by placing coils distal to the fistula or by inflating a balloon proximally. No signs of recanalization appeared on short-term follow-up magnetic resonance imaging in all patients. All patients remained neurologically intact at the last available follow-up session (mean 6 years). Nonvertebral paraspinal AVFs along the segmental nerve are specific disease entities seen in children presenting with bruit and cardiomegaly. Endovascular embolization should be the treatment of choice for this rare disease.

Presacral Arteriovenous Fistula: Case Report

We describe a case of arteriovenous fistula in front of the sacrum. Drainage induced epidural venous dilation in the sacral spinal canal. The fistula was embolized endoarterially with n-butyl-2-cyanoacrylate via its iliac arterial feeders. In follow-up digital subtraction angiography 1 month later, the fistula was found to be totally closed. The patient was followed up clinically for 2.5 years. She has remained symptom-free. A previously healthy 43-year-old woman presented with severe gluteal and perineal pain and a local sensation of hyperesthesia. The primary computed tomographic scan of the lumbosacral spine was normal, and emergency laparoscopy showed no signs of any pathological lesions. Magnetic resonance imaging discovered an unidentified mass in the sacral spinal canal, and the patient was hospitalized for neurosurgery. However, surgery on this mass had to be discontinued because of profuse bleeding, and the patient was referred for angiography. Diagnostic catheter angiography revealed a high-flow arteriovenous fistula anterior to the sacrum, and the mass detected earlier by magnetic resonance imaging seemed to be a dilated epidural vein draining the fistula. The feeders of the fistula originated in both internal iliac arteries, and the fistula was occluded via these arteries in two angiographic sessions. A paraspinal arteriovenous fistula may have venous drainage through the epidural venous plexus, and the ectatic veins may induce radicular symptomology. To the best of our knowledge, a paraspinal fistula at such a presacral location has not been documented previously. An unidentified mass in the sacral spinal canal should be suspected of being a dilated vascular structure. Prompt angiographic examinations with an option for embolization should be performed, and open surgical intervention should be avoided.

Modern Management of Spinal and Spinal Cord Vascular Lesions

Spinal arteriovenous shunts affect all age groups from neonates to the elderly in connection with different entities. The authors present 7 illustrative cases of spinal and spinal cord vascular lesions with different etiology, angioarchitecture, symptoms, risks, and prognosis, but similar pathophysiology: spinal cord AVM, multifocal AVM with venous impairment, paraspinal arteriovenous fistulas in children, spinal dural AV fistula, and an arteriovenous malformation of the filum terminale. Therapy was consistent and demonstrated the benefit of combined treatment. Specific endovascular embolisation with a permanent liquid substance (NBCA) is the method of choice. In 5 of the 7 patients, the malformation was completely occluded in one therapeutic session. Two patients needed additional embolisation. Systemic or neurological symptoms improved or regressed completely in all cases. No patient has had more than 3 sessions of endovascular approach. The filum terminale AVM was treated by direct surgery due to the risks of endovascular approach. As shown by our observations, venous flow in the intrinsic network of the spinal cord is highly sensitive to hemodynamic changes. Thus, the hemodynamic balance must be maintained to obtain stable embolisation results, particularly if a considerable size reduction of the AV shunt has been achieved.

Pediatric Thoraco-lumbar Paraspinal Arteriovenous Fistulas along the Segmental Nerve

To characterize the clinical presentation, imaging features and endovascular treatment of paraspinal non-vertebral arteriovenous fistulas along the segmental nerve. Retrospective review was performed on the five patients identified in our database covering 1985 to 2003. All patients presented with an incidentally found continuous murmur over the upper paraspinal or parasternal regions before three years old. In four patients, the AV fistula was in the mid-thoracic level and at L3 in one. All AV fistulas were a high-flow single-hole fistula at the neural foramen with venous drainage into paraspinal and epidural veins without intradural reflux. All fistulas were endovascularly occluded in the same session as the diagnostic angiography. The fistula was occluded with detachable coils in one case and with N-butylcyanoacrylate (NBCA) with flow control in four cases. Complete occlusion of the fistula was obtained in all cases and all patients remained neurologically intact at the last follow up (average six years). Non-vertebral paraspinal arteriovenous fistula along the segmental nerve is a specific disease entity seen in children. Embolization is the first choice of treatment for this disease.