Transvenous Embolisation of Dural Arteriovenous Fistulas with Combination of Guglielmi Detachable Coils and Onyx: Preliminary Experience and Evaluation of the Clinical Outcomes

Abstract

Introduction: The current mainstay treatment strategy for dural arteriovenous fistulas (DAVFs) is endovascular therapy. The use of transarterial Onyx 18 for treatment of DAVFs has been established, but there is limited literature on transvenous embolisation of DAVFs using Onyx 18 and Guglielmi detachable coils (GDCs). We herein present our preliminary experience of combined use of Onyx 18 and GDCs in treatment of DAVFs using a transvenous approach. Endovascular techniques, clinical and angiographic outcomes, and complications are discussed. We aimed to share our experiences to provide a foundation for future studies to improve patient care. Methods: We retrospectively analysed all patients with DAVF (n=5, age 23-60 years) with endovascular treatment using Onyx 18 and GDCs performed in the same session, who were treated in our institution between 2014 and 2015. The double-catheter technique with transvenous approach was performed in all five cases. Treatment response and complications were evaluated clinically. We assessed the treatment outcomes with digital subtraction angiogram at 6 months and 18 months after embolisation, assessing the degree of residual arteriovenous shunting and presence of cortical venous reflux. Results: Among the five reviewed cases, all achieved symptom alleviation. In two (40%) cases of DAVFs complete obliteration was achieved in the first session of embolisation; in one case significant reduction of arteriovenous shunting was achieved. In two (40%) cases, significant reduction of flow into DAVF was achieved after two separate sessions of embolisation. There were no reported cases of new neurological deficits after the procedures. Conclusion: Onyx 18 in combination with GDCs using transvenous approach for DAVF treatment is a safe and feasible method, with a reasonably high success rate in a small sample. As DAVF is a spectrum of diseases with different severities and locations, treatment approaches should be highly individualised and a multidisciplinary approach should be adopted.