title: Rapid and progressive venous thrombosis after occlusion of high-flow arteriovenous fistula.
abstract: BACKGROUND
  Cerebral venous thrombosis developing after surgical or endovascular obliteration of arteriovenous fistula (AVF) is a rare but devastating complication that has not been adequately reported.
  
  
  METHODS
  Two patients presenting with AVF (1 pial, 1 dural) and large venous pouches were successfully treated by surgical and endovascular means and were neurologically intact postoperatively. Rapid neurologic deterioration was seen on postoperative day 5 in the first patient and postoperative day 2 in the second patient. Both patients had massive cerebral venous thromboses on brain imaging and surgical exploration. One patient died and the other was severely disabled.
  
  
  CONCLUSIONS
  Rapid occlusion of a high-flow AVF resulting in significant venous stasis can precipitate thrombosis of the venous system distal to the fistulous point. In the presence of large venous pouches and significant venous stasis, strict therapeutic anticoagulation may be required to prevent cerebral venous thrombosis. Therapeutic anticoagulation, though feasible following endovascular treatment, may prove particularly challenging after open surgical interventions given the risk of hemorrhagic complications.
authors.affiliation: Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. Electronic address: fernando.gonzalez@jefferson.edu.
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.forename: Sonia
authors.initials: S
authors.lastname: Teufack
authors.forename: Felipe C
authors.initials: FC
authors.lastname: Albuquerque
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
mesh_terms: D000293:Adolescent; D001164:Arteriovenous Fistula / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D001921:Brain / Q000473:pathology / Q000601:surgery; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000379:methods*; D017809:Fatal Outcome; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology; D011183:Postoperative Complications / Q000628:therapy*; D020127:Recovery of Function; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy*
keywords: AVF; Arteriovenous; Arteriovenous fistula; CT; Computed tomography; Dural; Fistulas; ICH; Intracerebral hemorrhage; MRI; Magnetic resonance imaging; Onyx; Pial; Sinus thrombosis; Surgical clipping