Neurointervention · IR Playbook

Endovascular Embolization of Spinal Arteriovenous Malformation or Fistula (Spinal AVM/AVF embolization)

Endovascular embolization of a spinal arteriovenous shunt delivers liquid embolic through a segmental arterial feeder to obliterate the arteriovenous connection and restore normal spinal venous drainage. The mechanism that makes it work also defines its failure and complication profile: the shunt arterialises the coronal venous plexus, raises spinal venous pressure and causes congestive myelopathy, so cure requires the embolic cast to cross the fistulous point and occlude the first segment of the proximal draining vein — occluding only the feeding artery drops flow temporarily but the shunt reconstitutes through collaterals. Because the embolic travels in arteries that may also supply the cord, reflux into an anterior or posterior spinal artery produces cord infarction, and occluding venous outflow without closing the shunt produces venous infarction or haemorrhage. In pooled data for spinal dural arteriovenous fistula, endovascular treatment achieved complete occlusion at last follow-up in 72.5 percent versus 96.8 percent for surgery, with initial treatment failure of 32.2 percent versus 2.3 percent, so embolization is chosen on angioarchitecture rather than by default.

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