Ten-Year Retrospective Study on the Management of Spinal Arteriovenous Lesions: Efficacy of a Combination of Intraoperative Digital Subtraction Angiography and Intraarterial Dye Injection.

Abstract

The goal of treatment for spinal arteriovenous lesions is to completely obliterate the shunt. In our institution, intraoperative digital subtraction angiography and intraarterial injection of contrast agent have been used to accurately identify the site of arteriovenous shunts. We describe the intraoperative digital subtraction angiography and intraarterial dye injection procedures and how they may improve surgical outcomes. We retrospectively investigated 22 patients with intradural arteriovenous lesions (n = 19) or spinal dural arteriovenous fistulas (n = 3). A microcatheter was used during the procedures to avoid catheter migration. There were 29 procedures performed. To support the surgical procedures, indigo carmine was used 17 times and indocyanine green was used 12 times. There were no complications associated with these procedures. The indocyanine green procedure required a lower concentration of dye in the artery than in the vein to clarify the shunt point and visualized complex lesions more clearly. These methods allowed surgeons to orientate the complex vessel structure. Intraoperative digital subtraction angiography and intraarterial dye injection are useful tools for management of spinal arteriovenous lesions.