title: Transvenous embolization of intracranial dural arteriovenous shunts through occluded venous segments: experience in 51 Patients.
abstract: OBJECTIVE
  DAVFs with cortical venous reflux carry a high risk of morbidity and mortality. Endovascular treatment options include transarterial embolization with a liquid embolic agent or transvenous access with occlusion of the involved venous segment, which may prove difficult if the venous access route is thrombosed. The aim of this article is to describe the technique and results of the transvenous approach via thrombosed venous segments for occlusion of DAVFs.
  
  
  METHODS
  Our study was a retrospective analysis of 51 patients treated with a transvenous approach through an occluded sinus that was reopened by gentle rotational advancement of a 0.035-inch guidewire, which opened a path for a subsequently inserted microcatheter.
  
  
  RESULTS
  Of 607 patients with DAVFs, the transvenous reopening technique was attempted in 62 patients in 65 sessions and was successful in 51 patients and 53 sessions. Immediate occlusion was seen in 42 patients; on follow-up, occlusion was seen in 49 patients, whereas 2 patients had reduced flow without cortical venous reflux. No permanent procedure-related morbidity was noted.
  
  
  CONCLUSIONS
  The reopening technique to gain access to isolated venous pouches or the cavernous sinus for the treatment of DAVFs is a safe and effective treatment, which should be considered if transarterial approaches fail or are anticipated to result only in an incomplete anatomic cure.
authors.affiliation: Division of Interventional Neuroradiology, Department of Radiology, Mahidol University, Ramathibodi Hospital Medical School, Pyathai, Bangkok, Thailand.
authors.forename: E
authors.initials: E
authors.lastname: Lekkhong
authors.forename: S
authors.initials: S
authors.lastname: Pongpech
authors.forename: K
authors.initials: K
authors.lastname: Ter Brugge
authors.forename: P
authors.initials: P
authors.lastname: Jiarakongmun
authors.forename: R
authors.initials: R
authors.lastname: Willinsky
authors.forename: S
authors.initials: S
authors.lastname: Geibprasert
authors.forename: T
authors.initials: T
authors.lastname: Krings
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods / Q000401:mortality; D002550:Cerebral Veins / Q000000981:diagnostic imaging*; D004621:Embolization, Therapeutic / Q000379:methods* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome