Onyx Embolization of Spinal Arteriovenous Fistula via Scepter Balloon.

Abstract

Spinal arteriovenous fistulas (AVFs) are a rare entity that can have devastating neurologic outcomes. Currently, these lesions are treated via open microsurgical resection or transarterial embolization with good success. However, some patients cannot be treated with a minimally invasive endovascular technique secondary to difficulty catheterizing their vascular anatomy. Our aim is to present a case of balloon-assisted Onyx embolization of a spinal AVF. We present the case of a 59-year-old male with progressive lower back pain with lower-extremity weakness. We performed a spinal angiogram where an AVF was identified with very torturous anatomy. The patient was originally treated with open microsurgical resection; however, ≈6 weeks later the fistula and symptoms returned. At that time, we were able to treat the lesion with the Scepter-C balloon. We present a challenging case in which normal embolization microcatheters were unable to navigate difficult anatomy, but we were able to gain access and obliterate the fistula by using a balloon catheter.