A case of spinal ventral epidural arteriovenous fistula of the lumbar spine successfully treated by transarterial embolization by using a triaxial system

Abstract

• Abstract • Objective: We report a case of spinal ventral epidural arteriovenous fistula (SVEDAVF) which was successfully treated by using a triaxial system for transarterial embolization (TAE) with N-butyl 2-cyanoacrylate (NBCA). Case presentation: A 78-year-old man developed gradual progression of sensorimotor disturbance of lower extremities and vesicorectal dysfunction due to myelopathy, and was admitted to our hospital. Workup imaging studies revealed SVEDAVF at the third lumbar spine and perimedullary venous congestion which was responsible for the myelopathy. Bilateral dorsal somatic branches of the third lumbar artery were connected to the fistula. Although, the fistula was located on the left side of the ventral epidural venous plexus, the branch on the right side was the dominant feeding artery. Therefore, we performed TAE via the third lumbar artery on the right side. In order to deliver a microcatheter to the retrocorporeal anastomosis steadily, we inserted an intermediate catheter in between a guiding catheter and a microcatheter to make the catheter system to a triaxial one. As a result, the fistula was successfully occluded with NBCA. Conclusion:The triaxial system provided a good distal accessibility that resulted in safe and effective TAE.• Key words • spinal ventral epidural arteriovenous fistula, endovascular treatment, transarterial embolization, triaxial system 土浦協同病院 脳神経外科 ＜連絡先：芳村雅隆 〒 300-0053 茨城県土浦市真鍋新町 11-7 E-mail：mstkktsm@yahoo.co.jp ＞