Abstract：
BACKGROUND: Here we describe our experience managing intracranial dural arteriovenous fistulas (DAVFs) via endovascular embolization using a transarterial embolization (TAE) technique with liquid embolic agents. We illustrate the technical nuance of using dual arterial access for angiographic control runs in complex DAVFs supplied by multiple feeders from 2 distinct arterial systems.
METHODS: Retrospective analysis of intracranial DAVF embolization as a single treatment technique at our institution from 2013 to 2023.
RESULTS: Twenty-three patients with intracranial DAVF who underwent endovascular treatment as their initial treatment were included. All embolizations were approached transarterially with Onyx (n = 19), n-butyl cyanoacrylate (n = 2), or a combination (n = 2). Twenty-two patients (96%) had angiographic evidence of complete fistula obliteration after initial embolization. Six DAVF TAEs were performed with dual arterial access for simultaneous embolic delivery and angiographic control intraoperatively. Two patients recanalized twice postprocedure, 1 of whom was found to have incidental new DAVF at follow-up. Median patient follow-up was 12 months (interquartile range, 6-36 months), with a median modified Rankin Scale score on discharge of 1 and a Glasgow Outcome Scale score at 3 months of 5.
CONCLUSIONS: In this initial series of patients with DAVF managed by endovascular embolization, dual arterial access was feasible, safe, and effective in achieving fistula obliteration. Dual-arterial access conveniently provides simultaneous access for control angiography and embosylate delivery intraoperatively.
METHODS: Retrospective analysis of intracranial DAVF embolization as a single treatment technique at our institution from 2013 to 2023.
RESULTS: Twenty-three patients with intracranial DAVF who underwent endovascular treatment as their initial treatment were included. All embolizations were approached transarterially with Onyx (n = 19), n-butyl cyanoacrylate (n = 2), or a combination (n = 2). Twenty-two patients (96%) had angiographic evidence of complete fistula obliteration after initial embolization. Six DAVF TAEs were performed with dual arterial access for simultaneous embolic delivery and angiographic control intraoperatively. Two patients recanalized twice postprocedure, 1 of whom was found to have incidental new DAVF at follow-up. Median patient follow-up was 12 months (interquartile range, 6-36 months), with a median modified Rankin Scale score on discharge of 1 and a Glasgow Outcome Scale score at 3 months of 5.
CONCLUSIONS: In this initial series of patients with DAVF managed by endovascular embolization, dual arterial access was feasible, safe, and effective in achieving fistula obliteration. Dual-arterial access conveniently provides simultaneous access for control angiography and embosylate delivery intraoperatively.
摘要：
目的：描述通过使用液体栓塞剂的经动脉栓塞技术通过血管内栓塞治疗颅内硬脑膜动静脉瘘（DAVF）的经验。我们说明了在复杂的DAVF中使用双动脉通道进行血管造影控制的技术细微差别，该DAVF由来自两个不同动脉系统的多个进料器提供。
方法：回顾性分析2013-2023年在我们机构作为单一治疗技术的颅内DAVF栓塞。
结果：纳入了23例接受血管内治疗作为初始治疗的颅内DAVF患者。所有栓塞均通过Onyx（n=19）经动脉（TAE）进行，NBCA（n=2），或组合（n=2）。96％（n=22）的患者在初次栓塞后有血管造影证据表明瘘管完全闭塞。通过双动脉通路进行了六个DAVFTAE，在术中同时进行栓塞输送和血管造影控制。两名患者（2/22）术后两次再通，其中一名患者在随访中发现偶然出现了新的DAVF。中位患者随访时间为12个月（IQR：6-36），出院时的中位mRS为1，GOS为3个月5。
结论：在这一系列最初的DAVF患者中，通过血管内栓塞治疗，作者发现双动脉通路是可行的，安全,并有效实现瘘管消除。双动脉通路方便地提供了用于控制血管造影术和在手术中体现递送的同时通路。
方法：回顾性分析2013-2023年在我们机构作为单一治疗技术的颅内DAVF栓塞。
结果：纳入了23例接受血管内治疗作为初始治疗的颅内DAVF患者。所有栓塞均通过Onyx（n=19）经动脉（TAE）进行，NBCA（n=2），或组合（n=2）。96％（n=22）的患者在初次栓塞后有血管造影证据表明瘘管完全闭塞。通过双动脉通路进行了六个DAVFTAE，在术中同时进行栓塞输送和血管造影控制。两名患者（2/22）术后两次再通，其中一名患者在随访中发现偶然出现了新的DAVF。中位患者随访时间为12个月（IQR：6-36），出院时的中位mRS为1，GOS为3个月5。
结论：在这一系列最初的DAVF患者中，通过血管内栓塞治疗，作者发现双动脉通路是可行的，安全,并有效实现瘘管消除。双动脉通路方便地提供了用于控制血管造影术和在手术中体现递送的同时通路。
