[Endovascular treatment of non-galenic pial arteriovenous fistulas].
OBJECTIVE
Pial arteriovenous fistulas are infrequent vascular malformations. They are generally congenital and their natural history is ominous. The objective of this work is to describe our experience in their endovascular management and to review the existing literature.


METHODS
This is a retrospective and descriptive study of patients treated by endovascular approach during 3 years at 3 Latin-American hospitals.


RESULTS
The study included 6 patients with a mean age of 22 years. One case was caused by cranial trauma. In total, 50% suffered intracranial haemorrhage and 66% developed symptoms attributable to volume effect or retrograde blood flow. Intracranial varices were identified by CT and MRI scans in 83% of cases. Digital subtraction angiography showed arteriovenous fistulas from anterior circulation in 67% of cases and deep venous drainage in 50%. One endovascular procedure was performed in 5 cases (83%), while 2 procedures were required in one case. A single embolic agent was used to occlude fistulas in 67% of cases; whilst 33% required a combination. Coils were used in 4 cases (67%) and onyx was injected in another 4 (67%). One case required stent and balloon deployment. The fistulas were uneventfully occluded in all cases. The follow-up period was one year in 5 cases and 6 months in one case. All patients remained symptom-free.


CONCLUSIONS
Endovascular management can be considered as the treatment of choice. It consists in the embolisation of arterial pedicles with one or more embolic agents and should be performed as close as possible to the drainage vein, avoiding migration of the embolic agent towards the venous side.
Servicio de Neurocirugía, Hospital de Especialidades, Centro Médico Nacional La Raza, México Distrito Federal, México, Departamento de Neurocirugía, Universidad Nacional Autónoma de México, México.
Jorge Arturo
JA
Santos-Franco
Roberto
R
Santos-Ditto
Carlos
C
Valle-Ochoa
Angel
A
Lee Aguirre
Miguel Antonio
MA
Sandoval-Balanzario
Cuauhtemoc
C
Sánchez-Rodríguez
Antonio
A
García-Méndez
Erick
E
Ramos-Martínez
D001164:Arteriovenous Fistula; D004621:Embolization, Therapeutic; D006801:Humans; D011145:Polyvinyls; D012189:Retrospective Studies; D016896:Treatment Outcome
D011145:Polyvinyls