Chronic venous congestion following embolization of spinal dural arteriovenous fistula

Abstract

<jats:p>The authors present a case of spinal dural arteriovenous fistula with fluctuations in symptoms following embolization. Superselective injection of 33% <jats:italic>N</jats:italic>-butyl cyanoacrylate into the feeding vessel resulted in the complete occlusion of the fistula with traversal of the nidus. The subsequent venous congestion was progressive and treatable with anti-thrombin therapy. Extended medication with dual antiplatelet therapy was required because dose reduction to aspirin monotherapy worsened symptoms. In this case, it took &gt; 2 months for the patient's symptoms to stabilize. The duration of progressive venous thrombosis after embolization of a spinal dural arteriovenous fistula is not well known, nor is the most adequate treatment. Although it is presumed that prevention of venous thrombosis is best achieved with anticoagulation, dual antiplatelet therapy can be a substitute for patients with poor compliance.</jats:p>

Acute Spinal Subdural Hematoma after Vertebroplasty: A Case Report Emphasizing the Possible Etiologic Role of Venous Congestion

“…40 Similar neurologic deficits related to intraspinal venous hypertension and hypoxia have already been reported after venous thrombosis and venous outflow obstruction during embolization of spinal dural arteriovenous fistulas. 41 Additionally, the occurrence of a special form of chronic necrotic myelopathy is a well-known phenomenon related to the chronic venous congestion that occurs in patients with spinal dural arteriovenous fistulas (the so-called Foix-Alajouanine syndrome). 42 …”

Therapeutic Clues In Spinal Dural Arteriovenous Fistulas – A 30 Year Experience Of 156 Cases

“…They are considered to be highfl ow, extramedullary vascular lesions and the most common type of spinal vascular malformations. SDAVF constitute approximately 70 -80 % of all spinal cord vascular lesions and they are found primarily in men older than 50 years [8,24] . The fi stulas are most often fed by a single radicular artery that primarily supplies the dura mater.…”

Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition

“…In Japan, it has been used during hysterosalpingography and lymphangiography. When NBCA is mixed with Lipiodol, the NBCA becomes radiopaque, and its polymerization time is increased [119,131,168,182]. The intravascular administration of Lipiodol is not approved for use by the Japanese pharmaceutical law or in any other country except France.…”