Transvenous Doppler guidewire sonographic monitoring during treatment of a complex vertebral arteriovenous fistula associated with neurofibromatosis type 1.
A Doppler sonographic guidewire was used to monitor incremental changes in draining vein (DV) flow during endovascular occlusion of a complex vertebral arteriovenous fistula (AVF) in a patient with neurofibromatosis type 1. Transvenous monitoring of average peak velocity (APV) and the maximum-minus-minimum peak velocity (MxPV-MnPV) demonstrated a progression from a highly pulsatile, fast flow before embolization to a nonpulsatile, slow flow indicating a successful occlusion of the AVF (hemodynamic endpoint of treatment). Prior to this, apparent angiographic occlusion of the AVF was thought to signify a successful endpoint; however, persistently elevated values for APV and MxPV-MnPV in the DV signalled the presence of an additional contralateral arterial contribution. Transvenous monitoring of flow velocity appears to be ideally suited to establishing a hemodynamic endpoint of embolotherapy in the presence of complex arteriovenous shunting, as may occur with the vasculopathy of neurofibromatosis.
Murayama
Y
Y
Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
Usami
S
S
Abe
T
T
Hata
Y
Y
Ganaha
F
F
Massoud
T F
TF
D000328:Adult; D001164:Arteriovenous Fistula / Q000150:complications / Q000151:congenital* / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D008991:Monitoring, Physiologic; D009456:Neurofibromatosis 1 / Q000150:complications*; D011673:Pulsatile Flow; D018608:Ultrasonography, Doppler; D014711:Vertebral Artery