Spinal Dural Arteriovenous Fistulas Are Not Associated With Prothrombotic Factors

Abstract

Background and Purpose-The cause of spinal dural arteriovenous fistulas (SDAVF) is unknown. In intracranial dural arteriovenous fistulas, an association with factor V Leiden mutation has been found. Therefore, we studied the association between prothrombotic factors and SDAVF. Methods-Factor V Leiden mutation, factor II mutation, protein S, protein C, factor VIII, von Willebrand factor, antithrombin III, and lupus anticoagulant were determined by means of standard laboratory tests in 40 patients and 119 control subjects matched for sex and age. Results-Factor V Leiden mutation was not found in the patient group and was found twice in the control group. Factor II mutation was found in 1 patient and in none of the control subjects. There was no decreased activity of protein S, protein C, factor VIII, von Willebrand factor, or antithrombin III in patients in comparison with controls. Lupus anticoagulant was not found in the patient group and once in the control subjects. Conclusions-We conclude that it is unlikely that prothrombotic factors are involved in the pathogenesis of spinal dural arteriovenous fistulas, but subtle associations are not ruled out. Key Words: arteriovenous fistula Ⅲ spinal cord Ⅲ thrombophilia T he cause of spinal dural arteriovenous fistulas (SDAVF) is unknown. Infection 1 and trauma 2 are among the factors that have been proposed as possible factors in the course of events leading to this condition. In intracranial dural arteriovenous fistulas, an association with factor V Leiden mutation has been found, 3,4 whereas venous (sinus) thrombosis has also been implicated in the pathogenesis of that condition. 5 Because of the similarities between cerebral and spinal fistulas, thrombophilia might also operate in patients with SDAVF. Therefore, we investigated the association between prothrombotic factors and SDAVF. Patients and MethodsBetween 1990 and 2002, 68 patients had SDAVF diagnosed and treated in the 4 hospitals mentioned in this article. Of these 68 patients, 12 had died (5 from cardiovascular disease, 2 from cancer, 2 from pneumonia, and 3 from unknown causes). Of the 56 survivors, 3 patients could not be traced, 4 patients did not respond, and 7 refused to participate in the study. In 2 patients no blood could be drawn. In 1 patient who died of an unknown cause, the medical history revealed pulmonary embolism; the medical history did not contain information about presence or absence of prothrombotic factors. The patient characteristics of the 28 patients who did not participate in this study did not differ from those of the 40 patients who participated.The 40 patients were included in the current study between May and July 2002. The diagnosis of SDAVF was confirmed by angiography in all patients. From the medical records, we collected information on medical history, clinical features, time to diagnosis, and level of fistula. The clinical features of these patients have been described in more detail in a previous article. 6 The patients had been treated in the Elisabeth Hospital Tilburg ...

Thrombophilic Risk Factors in Patients With Cranial and Spinal Dural Arteriovenous Fistulae

“…Preliminary data from this study showed a significantly increased rate of the heterozygote G20210A mutation of the prothrombin gene in patients with cDAVF (13). Trauma (12) and infection (20) are discussed in the pathogenesis for sDAVF. sDAVF are fed by a radicular artery, which drains into a medullary vein and fills the coronal venous plexus of the spinal cord in a retrograde manner.…”

“…Although a few authors consider hypercoagulopathy in the pathogenesis of cDAVF (13,19,20,(23)(24)(25)44), findings in their studies are not uniform. In this study, 35% of patients with cDAVF and sDAVF had thrombophilic risk factors.…”

“…A study published by Jellema et al (20) included 40 patients with sDAVF and found only 1 patient with the G20210A mutation of the prothrombin gene, but none of the patients had factor V Leiden mutation. The authors concluded that it is unlikely that prothrombotic factors are involved in the cantly between patients with cDAVF (54.6 Ϯ 13.3 year) and patients with sDAVF (65.8 Ϯ 11.3 year; P Ͻ 0.05, t test).…”

Spinal Vascular Lesions

“…Interestingly, in contrast to cranial dAVFs, in which venous sinus thrombosis is believed to contribute to the development of those lesions, prothrombotic conditions are not associated with spinal dAVFs. 31 3. Spinal dAVFs are associated with infection, 32 syringomyelia, 33 spine trauma, 34 and surgery.…”

Thoracic radicular vessels by simultaneous intra‐arterial and intravenous injection of araldite

“…It is not known why these fistulas develop. Trauma and thrombophilia do not seem to play an important etiological role (Jellema et al, 2004).…”