title: Recurrence of "cured" dural arteriovenous fistulas after Onyx embolization.
abstract: Endovascular embolization with Onyx has been increasingly used to treat intracranial and spinal dural arteriovenous fistulas (DAVFs). Several case series have been published in recent years reporting high DAVF cure rates with this technique. Although it is seldom reported, DAVF recurrence may occur despite initial "cure." The authors present 3 separate cases of a recurrent DAVF after successful transarterial Onyx embolization. Despite adequate Onyx penetration into the fistula and draining vein, these cases demonstrate that DAVF recanalization may reappear with filling from previous or newly recruited arterial feeders. Other published reports of DAVF recurrence are examined, and potential contributory factors are discussed. These cases highlight the need for awareness of this possible phenomenon and suggest that follow-up angiography should be considered in patients treated with catheter embolization.
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. peter.adamczyk@med.usc.edu
authors.forename: Peter
authors.initials: P
authors.lastname: Adamczyk
authors.forename: Arun Paul
authors.initials: AP
authors.lastname: Amar
authors.forename: William J
authors.initials: WJ
authors.lastname: Mack
authors.forename: Donald W
authors.initials: DW
authors.lastname: Larsen
mesh_terms: D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls / Q000627:therapeutic use*; D012008:Recurrence; D013116:Spinal Cord / Q000098:blood supply / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D011145:Polyvinyls; C020320:ethylene-vinyl alcohol copolymer