Transvenous Embolization of Dural Arteriovenous Fistulas Through the Galenic (Deep Venous) System: Multicenter Case Series and Meta-Analysis

Visish M. Srinivasan; Katherine Karahalios; Marco Colasurdo; Emmajane Rhodenheiser; Lea Scherschinski; Tyler T. Lazaro; Gustavo Cortez; Bradley A. Gross; Anna Luisa Kühn; Ajit Puri; Ethan A. Winkler; Joshua S. Catapano; Yosuke Akamatsu; Ajith Thomas; Ricardo A. Hanel; Ajay Wakhloo; Ashutosh P. Jadhav; Andrew F. Ducruet; Felipe C. Albuquerque; Peter Kan

doi:10.1227/ons.0000000000000873

Transvenous Embolization of Dural Arteriovenous Fistulas Through the Galenic (Deep Venous) System: Multicenter Case Series and Meta-Analysis

Visish M. Srinivasan, Katherine Karahalios, Marco Colasurdo, Emmajane Rhodenheiser, Lea Scherschinski, Tyler T. Lazaro, Gustavo Cortez, Bradley A. Gross, Anna Luisa Kühn, Ajit Puri, Ethan A. Winkler, Joshua S. Catapano, Yosuke Akamatsu, Ajith Thomas, Ricardo A. Hanel, Ajay Wakhloo, Ashutosh P. Jadhav, Andrew F. Ducruet, Felipe C. Albuquerque, Peter Kan

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND AND OBJECTIVES: Arteriovenous fistulas involving the deep venous system have often been treated with microsurgery or transarterial embolization. Increasing familiarity with transvenous navigation and improved endovascular access systems may facilitate transvenous embolization (TVE) for these rare and challenging lesions. METHODS: We performed a retrospective study of neurointerventional databases of 6 high-volume centers. We identified all cases of arteriovenous fistulas with deep transvenous embolizations for arteriovenous fistula. Details regarding demographics, fistula characteristics, treatment considerations, clinical outcomes, and fistula occlusion were obtained and analyzed. The meta-analysis used the same inclusion criteria. RESULTS: Seventeen cases of TVE were identified. The most common reasons for TVE included prior treatment failure with microsurgery (n = 2) or transarterial embolization (n = 3) or inaccessible arterial pedicles (n = 4). For patients with full clinical outcome data (n = 14), 2 patients had worsened modified Rankin Scale, 8 patients had no change, and 4 were improved at a median clinical follow-up of 3.5 months. Angiographic obliteration was achieved in 15/17 cases (88.2%). In 1 case, catheterization around a sharp turn in the basal vein of Rosenthal could not be performed. In another case, despite successful TVE, there was residual lesion which was treated 1 year later by microsurgical clipping and excision. CONCLUSION: Transvenous approaches for embolization of deep arteriovenous fistulas have become possible with modern endovascular catheter systems and liquid embolics. These lesions can be treated safely and effectively through endovascular approaches, whichmay spare patients the traversal of deep structures needed formicrosurgical approaches to these regions. The outcomes of TVE are comparable with published outcomes of microsurgical interruption.

Original language	English (US)
Pages (from-to)	489-498
Number of pages	10
Journal	Operative Neurosurgery
Volume	25
Issue number	6
DOIs	https://doi.org/10.1227/ons.0000000000000873
State	Published - Dec 25 2023
Externally published	Yes

Keywords

Arteriovenous
Deep
Embolization
Fistula
Onyx
Shunts
Transvenous
Vein of Galen
Vein of rosenthal

ASJC Scopus subject areas

General Medicine

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10.1227/ons.0000000000000873

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Srinivasan, V. M., Karahalios, K., Colasurdo, M., Rhodenheiser, E., Scherschinski, L., Lazaro, T. T., Cortez, G., Gross, B. A., Kühn, A. L., Puri, A., Winkler, E. A., Catapano, J. S., Akamatsu, Y., Thomas, A., Hanel, R. A., Wakhloo, A., Jadhav, A. P., Ducruet, A. F., Albuquerque, F. C., & Kan, P. (2023). Transvenous Embolization of Dural Arteriovenous Fistulas Through the Galenic (Deep Venous) System: Multicenter Case Series and Meta-Analysis. Operative Neurosurgery, 25(6), 489-498. https://doi.org/10.1227/ons.0000000000000873

Srinivasan, VM, Karahalios, K, Colasurdo, M, Rhodenheiser, E, Scherschinski, L, Lazaro, TT, Cortez, G, Gross, BA, Kühn, AL, Puri, A, Winkler, EA, Catapano, JS, Akamatsu, Y, Thomas, A, Hanel, RA, Wakhloo, A, Jadhav, AP, Ducruet, AF, Albuquerque, FC & Kan, P 2023, 'Transvenous Embolization of Dural Arteriovenous Fistulas Through the Galenic (Deep Venous) System: Multicenter Case Series and Meta-Analysis', Operative Neurosurgery, vol. 25, no. 6, pp. 489-498. https://doi.org/10.1227/ons.0000000000000873

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title = "Transvenous Embolization of Dural Arteriovenous Fistulas Through the Galenic (Deep Venous) System: Multicenter Case Series and Meta-Analysis",

abstract = "BACKGROUND AND OBJECTIVES: Arteriovenous fistulas involving the deep venous system have often been treated with microsurgery or transarterial embolization. Increasing familiarity with transvenous navigation and improved endovascular access systems may facilitate transvenous embolization (TVE) for these rare and challenging lesions. METHODS: We performed a retrospective study of neurointerventional databases of 6 high-volume centers. We identified all cases of arteriovenous fistulas with deep transvenous embolizations for arteriovenous fistula. Details regarding demographics, fistula characteristics, treatment considerations, clinical outcomes, and fistula occlusion were obtained and analyzed. The meta-analysis used the same inclusion criteria. RESULTS: Seventeen cases of TVE were identified. The most common reasons for TVE included prior treatment failure with microsurgery (n = 2) or transarterial embolization (n = 3) or inaccessible arterial pedicles (n = 4). For patients with full clinical outcome data (n = 14), 2 patients had worsened modified Rankin Scale, 8 patients had no change, and 4 were improved at a median clinical follow-up of 3.5 months. Angiographic obliteration was achieved in 15/17 cases (88.2%). In 1 case, catheterization around a sharp turn in the basal vein of Rosenthal could not be performed. In another case, despite successful TVE, there was residual lesion which was treated 1 year later by microsurgical clipping and excision. CONCLUSION: Transvenous approaches for embolization of deep arteriovenous fistulas have become possible with modern endovascular catheter systems and liquid embolics. These lesions can be treated safely and effectively through endovascular approaches, whichmay spare patients the traversal of deep structures needed formicrosurgical approaches to these regions. The outcomes of TVE are comparable with published outcomes of microsurgical interruption.",

keywords = "Arteriovenous, Deep, Embolization, Fistula, Onyx, Shunts, Transvenous, Vein of Galen, Vein of rosenthal",

author = "Srinivasan, {Visish M.} and Katherine Karahalios and Marco Colasurdo and Emmajane Rhodenheiser and Lea Scherschinski and Lazaro, {Tyler T.} and Gustavo Cortez and Gross, {Bradley A.} and K{\"u}hn, {Anna Luisa} and Ajit Puri and Winkler, {Ethan A.} and Catapano, {Joshua S.} and Yosuke Akamatsu and Ajith Thomas and Hanel, {Ricardo A.} and Ajay Wakhloo and Jadhav, {Ashutosh P.} and Ducruet, {Andrew F.} and Albuquerque, {Felipe C.} and Peter Kan",

year = "2023",

month = dec,

day = "25",

doi = "10.1227/ons.0000000000000873",

language = "English (US)",

volume = "25",

pages = "489--498",

journal = "Operative Neurosurgery",

issn = "2332-4252",

publisher = "Lippincott Williams and Wilkins",

number = "6",

}

TY - JOUR

T1 - Transvenous Embolization of Dural Arteriovenous Fistulas Through the Galenic (Deep Venous) System

T2 - Multicenter Case Series and Meta-Analysis

AU - Srinivasan, Visish M.

AU - Karahalios, Katherine

AU - Colasurdo, Marco

AU - Rhodenheiser, Emmajane

AU - Scherschinski, Lea

AU - Lazaro, Tyler T.

AU - Cortez, Gustavo

AU - Gross, Bradley A.

AU - Kühn, Anna Luisa

AU - Puri, Ajit

AU - Winkler, Ethan A.

AU - Catapano, Joshua S.

AU - Akamatsu, Yosuke

AU - Thomas, Ajith

AU - Hanel, Ricardo A.

AU - Wakhloo, Ajay

AU - Jadhav, Ashutosh P.

AU - Ducruet, Andrew F.

AU - Albuquerque, Felipe C.

AU - Kan, Peter

PY - 2023/12/25

Y1 - 2023/12/25

N2 - BACKGROUND AND OBJECTIVES: Arteriovenous fistulas involving the deep venous system have often been treated with microsurgery or transarterial embolization. Increasing familiarity with transvenous navigation and improved endovascular access systems may facilitate transvenous embolization (TVE) for these rare and challenging lesions. METHODS: We performed a retrospective study of neurointerventional databases of 6 high-volume centers. We identified all cases of arteriovenous fistulas with deep transvenous embolizations for arteriovenous fistula. Details regarding demographics, fistula characteristics, treatment considerations, clinical outcomes, and fistula occlusion were obtained and analyzed. The meta-analysis used the same inclusion criteria. RESULTS: Seventeen cases of TVE were identified. The most common reasons for TVE included prior treatment failure with microsurgery (n = 2) or transarterial embolization (n = 3) or inaccessible arterial pedicles (n = 4). For patients with full clinical outcome data (n = 14), 2 patients had worsened modified Rankin Scale, 8 patients had no change, and 4 were improved at a median clinical follow-up of 3.5 months. Angiographic obliteration was achieved in 15/17 cases (88.2%). In 1 case, catheterization around a sharp turn in the basal vein of Rosenthal could not be performed. In another case, despite successful TVE, there was residual lesion which was treated 1 year later by microsurgical clipping and excision. CONCLUSION: Transvenous approaches for embolization of deep arteriovenous fistulas have become possible with modern endovascular catheter systems and liquid embolics. These lesions can be treated safely and effectively through endovascular approaches, whichmay spare patients the traversal of deep structures needed formicrosurgical approaches to these regions. The outcomes of TVE are comparable with published outcomes of microsurgical interruption.

AB - BACKGROUND AND OBJECTIVES: Arteriovenous fistulas involving the deep venous system have often been treated with microsurgery or transarterial embolization. Increasing familiarity with transvenous navigation and improved endovascular access systems may facilitate transvenous embolization (TVE) for these rare and challenging lesions. METHODS: We performed a retrospective study of neurointerventional databases of 6 high-volume centers. We identified all cases of arteriovenous fistulas with deep transvenous embolizations for arteriovenous fistula. Details regarding demographics, fistula characteristics, treatment considerations, clinical outcomes, and fistula occlusion were obtained and analyzed. The meta-analysis used the same inclusion criteria. RESULTS: Seventeen cases of TVE were identified. The most common reasons for TVE included prior treatment failure with microsurgery (n = 2) or transarterial embolization (n = 3) or inaccessible arterial pedicles (n = 4). For patients with full clinical outcome data (n = 14), 2 patients had worsened modified Rankin Scale, 8 patients had no change, and 4 were improved at a median clinical follow-up of 3.5 months. Angiographic obliteration was achieved in 15/17 cases (88.2%). In 1 case, catheterization around a sharp turn in the basal vein of Rosenthal could not be performed. In another case, despite successful TVE, there was residual lesion which was treated 1 year later by microsurgical clipping and excision. CONCLUSION: Transvenous approaches for embolization of deep arteriovenous fistulas have become possible with modern endovascular catheter systems and liquid embolics. These lesions can be treated safely and effectively through endovascular approaches, whichmay spare patients the traversal of deep structures needed formicrosurgical approaches to these regions. The outcomes of TVE are comparable with published outcomes of microsurgical interruption.

KW - Arteriovenous

KW - Deep

KW - Embolization

KW - Fistula

KW - Onyx

KW - Shunts

KW - Transvenous

KW - Vein of Galen

KW - Vein of rosenthal

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U2 - 10.1227/ons.0000000000000873

DO - 10.1227/ons.0000000000000873

M3 - Article

C2 - 37747335

AN - SCOPUS:85182147671

SN - 2332-4252

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JO - Operative Neurosurgery

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IS - 6

ER -

Transvenous Embolization of Dural Arteriovenous Fistulas Through the Galenic (Deep Venous) System: Multicenter Case Series and Meta-Analysis

Abstract

Keywords

ASJC Scopus subject areas

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