Transarterial glue embolization using a balloon flow arrest technique for arteriovenous fistula

Abstract

Objective: Transarterial embolization (TAE) using liquid embolic material is adopted in the treatment of dural arteriovenous fi stulas (DAVFs) with direct cortical venous drainage or in patients in whom transvenous access is limited. Arresting fl ow by wedging a microcatheter tip into a main feeding vessel is important to achieve complete obliteration of DAVF with TAE. The Masamune catheter is a double lumen microcatheter with a silicone balloon at its distal end, characterized by the shortness of its catheter tip to the distal balloon end. Two cases of DAVF treated by TAE with the balloon fl ow arrest technique using a Masamune balloon microcatheter are reported. Case Report: Case 1, a 50-year-old man, was incidentally diagnosed with a tentorial DAVF with direct cortical venous drainage. An infl ated Masamune balloon catheter was wedged in the occipital artery, and trans-arterial embolization was performed under a fl ow-arrested condition. As preparative embolization of the other minor feeding arteries had not been performed, complete obliteration of DAVF was not achieved by competing fl ow. Case 2, a 64-year-old man, was diagnosed with a left transverse-sigmoid DAVF on angiogram. The DAVF was completely obliterated with the balloon fl ow arrest technique using liquid embolic material. Conclusion: The Masamune catheter can easily achieve an artificial flow-arrest condition by inflation of its distal balloon to prevent fragmentation of liquid embolic material. In conjunction with preparative embolization of minor feeding vessels, curative embolization may be achieved from a main feeder using this catheter.

Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms

“…In this approach, if the feeding artery is derived from branches of the ECA, embolization is easily performed and can decrease shunt flow. Nonetheless, achieving a complete cure is complicated in some cases because of the recruitment of a blood supply from collateral arteries and difficulty in the catheterization of the feeding arteries 30 . Therefore, a mixed approach of transarterial glue embolization and transvenous coil embolization is generally used in such cases to relieve symptoms.…”