A treatment option for nontraumatic adult-type dural arteriovenous fistulas: transarterial venous coil embolization.

Abstract

Transvenous coil embolization of the affected venous outlet is the most effective treatment method for the management of nontraumatic adult dural arteriovenous fistulas (DAVFs). However, such an approach is not always feasible. We discuss nontraumatic adult DAVFs that were treated with transarterial coil embolization of the proximal venous outlet at our facility, as well as cases previously reported in the literature. This study included 8 patients who had undergone transarterial coil embolization of the proximal venous outlet for the treatment of nontraumatic adult DAVFs (4 cases in our series and 4 cases in the literature). All clinical, angiographic, and procedural data were retrospectively collected from medical charts or the literature and recorded on standardized forms by a physician. The DAVFs were classified according to the venous drainage pattern. In all 8 patients, occlusion of the proximal venous site of the fistula was possible by using coils through the arterial feeders; this resulted in complete recovery in all patients. The access route for 7 of the 8 cases was the middle meningeal artery, and in 1 case was the meningohypophyseal artery. In all 8 patients the access artery was relatively smooth, with distal enlargement in the fistula region. If a distally enlarged feeding artery is observed among the multiple feeding arteries, it suggests the existence of a large fistula and may serve as an access route for transarterial venous coil embolization. This procedure may offer a more effective and safer treatment than other endovascular approaches.