Chronic venous congestion following embolization of spinal dural arteriovenous fistula

Case report

Restricted access

The authors present a case of spinal dural arteriovenous fistula with fluctuations in symptoms following embolization. Superselective injection of 33% N-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 > 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.

Abbreviations used in this paper: DAVF = dural arteriovenous fistula; MMT = manual muscle testing; NBCA = N-butyl cyanoacrylate.

Article Information

Address correspondence to: Tsuyoshi Ohta, M.D., Ph.D., 2-4-20, Ohgimachi, Kita-ku, Osaka, Japan, 530-8480. email: t-oota@kitano-hp.or.jp.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Axial (upper) and sagittal (lower) T2-weighted images of the spinal cord in chronological order. A and B: Images obtained before treatment. Flow voids behind the cord and a hyperintensity area in the cord are visible. C and D: Images obtained on exacerbation. Reduction of the flow voids and shrinkage of the hyperintensity area are shown. E and F: Images obtained 1 year after the embolization procedure. Complete disappearance of the flow voids and the hyper-intensity area are noted.

  • View in gallery

    Angiograms showing embolization of the spinal DAVF with NBCA. A: Pretreatment image showing the nidus (straight arrow) and the draining vein (angled arrow) of the spinal DAVF at the level of T-6. B: Superselective injection of 33% NBCA. Deposition of the NBCA into the perimedullary venous system (open arrow) was suspected. C: Image obtained just after the embolization procedure.

  • View in gallery

    Graph showing the clinical course according to the Aminoff–Logue grading scheme.

References

  • 1

    Aminoff MJLogue V: The prognosis of patients with spinal vascular malformations. Brain 97:2112181974

  • 2

    Antithrombotic Trialists' Collaboration: Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 324:71862002

    • Search Google Scholar
    • Export Citation
  • 3

    Berenstein ALasjaunias Pter Brugge KG: Surgical Neuroangiography BerlinSpringer2004. Vol 2.2:871

  • 4

    Criscuolo GROldfield EHDoppman JL: Reversible acute and subacute myelopathy in patients with dural arteriovenous fistulas. Foix-Alajouanine syndrome reconsidered. J Neurosurg 70:3543591989

    • Search Google Scholar
    • Export Citation
  • 5

    Geerts WHPineo GFHeit JABergqvist DLassen MRColwell CW: Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126:3 Suppl338S400S2004

    • Search Google Scholar
    • Export Citation
  • 6

    Gilbertson JRMiller GMGoldman MSMarsh WR: Spinal dural arteriovenous fistulas: MR and myelographic findings. AJNR Am J Neuroradiol 16:204920571995

    • Search Google Scholar
    • Export Citation
  • 7

    Gillot C: The infrarenal vena cava. Anat Clin 2:3013151981

  • 8

    Hovens MMSnoep JDTamsma JTHuisman MV: Aspirin in the prevention and treatment of venous thromboembolism. J Thromb Haemost 4:147014752006

    • Search Google Scholar
    • Export Citation
  • 9

    Jellema KSluzewski Mvan Rooij WJTijssen CCBeute GN: Embolization of spinal dural arteriovenous fistulas: importance of occlusion of the draining vein. J Neurosurg Spine 2:5805832005

    • Search Google Scholar
    • Export Citation
  • 10

    Jellema KTijssen CCvan Gijn J: Spinal dural arteriovenous fistulas: a congestive myelopathy that initially mimics a peripheral nerve disorder. Brain 129:315031642006

    • Search Google Scholar
    • Export Citation
  • 11

    Mascalchi MFerrito GQuilici NMangiafico SCosottini MCellerini M: Spinal vascular malformations: MR angiography after treatment. Radiology 219:3463532001

    • Search Google Scholar
    • Export Citation
  • 12

    Nichols DARufenacht DAJack CR JrForbes GS: Embolization of spinal dural arteriovenous fistula with polyvinyl alcohol particles: experience in 14 patients. AJNR Am J Neuroradiol 13:9339401992

    • Search Google Scholar
    • Export Citation
  • 13

    Niimi YBerenstein ASetton ANeophytides A: Embolization of spinal dural arteriovenous fistulae: results and follow-up. Neurosurgery 40:6756831997

    • Search Google Scholar
    • Export Citation
  • 14

    Patrono CColler BFitzGerald GAHirsh JRoth G: Platelet-active drugs: the relationships among dose, effectiveness, and side effects: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126:3 Suppl234S264S2004

    • Search Google Scholar
    • Export Citation
  • 15

    Schulman SGranqvist SHolmström MCarlsson ALindmarker PNicol P: The duration of oral anticoagulant therapy after a second episode of venous thromboembolism. The Duration of Anticoagulation Trial Study Group. N Engl J Med 336:3933981997

    • Search Google Scholar
    • Export Citation
  • 16

    Stam J: Thrombosis of the cerebral veins and sinuses. N Engl J Med 352:179117982005

  • 17

    Steinmetz MPChow MMKrishnaney AAAndrews-Hinders DBenzel ECMasaryk TJ: Outcome after the treatment of spinal dural arteriovenous fistulae: a contemporary single-institution series and meta-analysis. Neurosurgery 55:77872004

    • Search Google Scholar
    • Export Citation
  • 18

    Tadié MHemet JFreger PClavier ECreissard P: Morphological and functional anatomy of spinal cord veins. J Neuroradiol 12:3201985

    • Search Google Scholar
    • Export Citation

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 178 178 22
Full Text Views 42 37 0
PDF Downloads 52 43 0
EPUB Downloads 0 0 0

PubMed

Google Scholar