title: Spinal ventral epidural arteriovenous fistulas of the lumbar spine: angioarchitecture and endovascular treatment.
abstract: BACKGROUND
  Spinal ventral epidural arteriovenous fistulas (EDAVFs) are relatively rare spinal vascular lesions. We investigated the angioarchitecture of spinal ventral EDAVFs and show the results of endovascular treatment.
  
  
  METHODS
  We reviewed six consecutive patients (four males and two females; mean age, 67.3 years) with spinal ventral EDAVFs treated at our institutions from May 2011 to October 2012. All patients presented with progressive myelopathy. The findings of angiography, including 3D/2D reformatted images, treatments, and outcomes, were investigated. A literature review focused on the angioarchitecture and treatment of spinal ventral EDAVFs is also presented.
  
  
  RESULTS
  The EDAVFs were located in the ventral epidural space at the L1-L5 levels. All EDAVFs were supplied by the dorsal somatic branches from multiple segmental arteries. The ventral somatic branches and the radiculomeningeal arteries also supplied the AVFs in two patients. The AVFs drained via an epidural venous pouch into the perimedullary vein in four patients and into both the perimedullary vein and paravertebral veins in two patients. Four cases without paravertebral drainage were treated by transarterial embolization with diluted glue, and two cases with perimedullary and paravertebral drainages were treated by transvenous embolization alone or in combination with transarterial embolization. An angiographic cure was obtained in all patients. Clinical symptoms resolved in two patients, markedly improved in three patients, and minimally improved in one patient.
  
  
  CONCLUSIONS
  In our limited experience, spinal ventral EDAVFs were primarily fed by somatic branches. EDAVFs can be successfully treated by endovascular techniques selected based on the drainage type of the AVF.
authors.affiliation: Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Yufu City, Oita, Japan 879-5593. hkiyosue@med.oita-u.ac.jp
authors.forename: Hiro
authors.initials: H
authors.lastname: Kiyosue
authors.forename: Shuichi
authors.initials: S
authors.lastname: Tanoue
authors.forename: Mika
authors.initials: M
authors.lastname: Okahara
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Hori
authors.forename: Junji
authors.initials: J
authors.lastname: Kashiwagi
authors.forename: Hiromu
authors.initials: H
authors.lastname: Mori
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000473:pathology* / Q000628:therapy*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000098:blood supply* / Q000473:pathology; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013116:Spinal Cord / Q000098:blood supply* / Q000473:pathology*; D016896:Treatment Outcome