Neurointervention · IR Playbook

Endovascular Embolization of Cranial Dural Arteriovenous Fistula (dAVF embolization)

Endovascular embolization of a cranial dural arteriovenous fistula (dAVF) is the transarterial or transvenous occlusion of an abnormal shunt between meningeal arteries and a dural venous sinus or a leptomeningeal vein. The mechanism that defines both the disease and the treatment is venous: arterial pressure transmitted retrogradely into cortical veins raises cortical venous pressure, producing congestion, non-haemorrhagic neurological deficit and haemorrhage, so cure requires occlusion of the fistulous point together with the proximal draining vein (the foot of the vein) rather than the arterial feeders, which simply recruit new supply. Persistent cortical venous reflux carries an annual haemorrhage rate of 8.1% and annual mortality of 10.4%. Transarterial embolization with ethylene-vinyl alcohol copolymer cures approximately two-thirds of accessible lesions and transvenous embolization cures 80-90% at ventral skull base locations, at an overall procedural complication rate of 7.7%.

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