Results of 1940 embolizations for dural arteriovenous fistulas: Japanese Registry of Neuroendovascular Therapy (JR-NET3)

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Embolization is the most common treatment for dural arteriovenous fistulas (dAVFs). A retrospective, multicenter observational study was conducted in Japan to clarify the nature, frequency, and risk factors for complications of dAVF embolization.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Patient data were derived from the Japanese Registry of Neuroendovascular Therapy 3 (JR-NET3). A total of 40,169 procedures were registered in JR-NET3, including 2121 procedures (5.28%) in which dAVFs were treated with embolization. After data extraction, the authors analyzed complication details and risk factors in 1940 procedures performed in 1458 patients with cranial dAVFs treated with successful or attempted embolization.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Transarterial embolization (TAE) alone was performed in 858 cases (44%), and transvenous embolization (TVE) alone was performed in 910 cases (47%). Both TAE and TVE were performed in one session in 172 cases (9%). Complications occurred in 149 cases (7.7%). Thirty-day morbidity and mortality occurred in 55 cases (2.8%) and 16 cases (0.8%), respectively. Non–sinus-type locations, radical embolization as the strategy, procedure done at a hospital that performed dAVF embolization in fewer than 10 cases during the study period, and emergency procedures were independent risk factors for overall complications.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Complication rates of dAVF embolization in Japan were acceptable. For better results, the risk factors identified in this study should be considered in treatment decisions.</jats:p></jats:sec>

Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas: A German Single-Center Experience

“…The complication- (3%) and procedure-related (0%) mortality rates in our cohort were acceptable and in line with previous studies [ 11 , 16 , 19 , 25 ]. To date, the largest case series on cranial DAVFs in the literature reported a complication rate of 7.7% and a mortality rate of 0.8% [ 11 ]. Although 2 patients were temporarily affected, no patients had permanent deficits.…”

“…In general, complications occurred in patients with DAVF location in the falcotentorial group (tentorial and anterior cranial fossa). This confirms the results of a recent study by Hiramatsu et al [11] that demonstrated nonsinus-type location as a predictor of complications. Other studies also showed increased complication rates for the tentorial location in up to 31% [23].…”

“…In patients with such complex fistulas, our in-house therapeutic objective is not primarily the immediate closure of the DAVF during 1 procedure, but rather a downstaging of the fistula with the elimination of CVR in a staged fashion, as radical embolization has been shown to be an independent predictor of complications [11]. We therefore pursue 2 different strategies which are dependent on the clinical presentation and angioarchitecture of the fistula.…”

“…For the majority of DAVFs, transarterial and/or transvenous embolization is nowadays considered the first-line therapy. The development of catheters and embolization techniques and agents has advanced in the last 2 decades, providing efficient fistula embolization with a minimally invasive approach [ 11 , 12 , 13 , 14 , 15 , 16 ]. The first steps were already made in the eighties when intracranial vascular malformations were treated with acryl glue [ 17 ], e.g., in combination with transvenous coil occlusion [ 18 ].…”

A Patient with an Anterior Condylar Confluence Dural Arteriovenous Fistula in Whom Reflux to the Anterior Medullary Vein Was Observed during Follow-Up

“…The incidence of ACC dAVFe is reportedly 3.8%. 6) The ACC is located in the extracranial cavity, being anatomically associated with several venous return routes; therefore, in patients with ACC dAVF, reflux from the inferior petrosal sinus (IPS) to the cavernous sinus and emissary-vein-mediated reflux to the anterior medullary vein (AMV) has been reported. 7) In this study, we report a patient with an ACC dAVF in whom reflux to the AMV appeared through a change in venous return during follow-up.…”