Are type I dural arteriovenous fistulas safe? Single-centre experience of endovascular treatment of dural arteriovenous fistulas

Abstract

Introduction There are mixed reports on the incidence of intracranial haemorrhage in patients with dural arteriovenous fistulas. We assessed new proposed risk factors (i.a. number of outflows and outflow diameter) of intracerebral haemorrhage due to intracranial dural arteriovenous fistula and presented our personal experience in endovascular treatment of dural arteriovenous fistulas. Material and methods The patient database from January 2006 and December 2016 was reviewed, and 25 patients with 28 dural arteriovenous fistulas were identified. Results 50% of patients presented with intracerebral haemorrhage. Multiple dural fistulas occurred in 12% of patients. Spearman’s rank correlation coefficient revealed that there was a strong association between Cognard classification type and time needed to treat ( r = 0.59, p < 0.05), as well as the volume of contrast used ( r = 0.77, p < 0.05). Infratentorial ( r = 0.53, p < 0.05) and right-sided ( r = 0.66, p < 0.05) localisation were more challenging to treat. Bleeding was associated with poorer clinical outcome ( r = 0.48, p < 0.05). No significant differences were found between the non-haemorrhagic group and the haemorrhagic group regarding the number of outflows ( p = 0.459) and largest outflow diameter ( p = 0.298). Clinical evaluation at follow-up was as follows: 56% of patients were asymptomatic, 24% had non-significant disability, maintaining independency, 16% had moderate disability, and 8% died – one in the course of intracerebral haemorrhage and one due to other sustained injuries. There were no reported embolisation-related complications. Conclusions To conclude, regardless of presentation, both symptomatic and asymptomatic dural arteriovenous fistulas deserve clinical attention, structured evaluation, and follow-up. Type I fistulas were associated with haemorrhage in 1/3 of all cases. Overall our results indicate that the risk of haemorrhage and dire consequences is multifactorial.

Hemorrhagic risk factors of endovascular onyx embolization of intracranial dural arteriovenous fistulas

“…The presence of large or giant venous aneurysm may prone to develop venous thrombosis after the decreasing the shunt flow. In a recent study, Brzozowski K et al 9 reviewed angiographic features of 25 DAVF patients and speculated mean outflow vein diameter might be associated with risk of hemorrhage before endovascular treatment. However, statistical analysis failed to recognize the association confined to the limited sample size.…”

“…Endovascular Onyx embolization has now been accepted as the primary treatment strategy to manage DAVFs. [5][6][7][8][9][10] There is still a lack of detailed information concerning the incidence and risk factors of hemorrhagic complications related to endovascular procedures. [2][3][4]6 In this article, we analyzed the possible risk factors for the hemorrhagic complication caused by endovascular embolization of DAVFs.…”

Utility of targeted balloon protection of the venous sinus for endovascular treatment of dural arteriovenous fistula by transarterial embolization with Onyx: A case report and literature review

“…[ 5 , 6 , 10 , 14 ] In general, fistulas occur in the areas of the transverse and sigmoid sinuses and can remain asymptomatic until the patient reaches middle age or older. [ 2 , 14 ] However, patients may report symptoms of serious neurological disorders often resulting from bleeding, so this condition requires appropriate therapeutic intervention. Treatment options typically include arterial and/or venous embolization followed by surgery or radiosurgery, as needed.…”

Intracranial haemorrhage in dural arteriovenous fistula

“…I read the article by Brzozowski et al about the percentage of intracranial haemorrhage in type I dural arteriovenous fistula with great interest [1]. In the paper, the authors demonstrated that 50% of patients with dural arteriovenous fistula presented with intracranial haemorrhage.…”