title: A treatment option for nontraumatic adult-type dural arteriovenous fistulas: transarterial venous coil embolization.
abstract: OBJECTIVE
  Transvenous coil embolization of the affected venous outlet is the most effective treatment method for the management of nontraumatic adult dural arteriovenous fistulas (DAVFs). However, such an approach is not always feasible. We discuss nontraumatic adult DAVFs that were treated with transarterial coil embolization of the proximal venous outlet at our facility, as well as cases previously reported in the literature.
  
  
  METHODS
  This study included 8 patients who had undergone transarterial coil embolization of the proximal venous outlet for the treatment of nontraumatic adult DAVFs (4 cases in our series and 4 cases in the literature). All clinical, angiographic, and procedural data were retrospectively collected from medical charts or the literature and recorded on standardized forms by a physician. The DAVFs were classified according to the venous drainage pattern.
  
  
  RESULTS
  In all 8 patients, occlusion of the proximal venous site of the fistula was possible by using coils through the arterial feeders; this resulted in complete recovery in all patients. The access route for 7 of the 8 cases was the middle meningeal artery, and in 1 case was the meningohypophyseal artery. In all 8 patients the access artery was relatively smooth, with distal enlargement in the fistula region.
  
  
  CONCLUSIONS
  If a distally enlarged feeding artery is observed among the multiple feeding arteries, it suggests the existence of a large fistula and may serve as an access route for transarterial venous coil embolization. This procedure may offer a more effective and safer treatment than other endovascular approaches.
authors.affiliation: Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea. Electronic address: skbaik9@gmail.com.
authors.forename: Seung Kug
authors.initials: SK
authors.lastname: Baik
authors.affiliation: Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Yong-Woo
authors.initials: YW
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Sang Weon
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Chang Hwa
authors.initials: CH
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Science and Engineering Institute, Kyungpook National University College of Medicine, Daegu, Korea.
authors.forename: Jaechan
authors.initials: J
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000379:methods; D020785:Central Nervous System Vascular Malformations / Q000473:pathology / Q000628:therapy*; D002533:Cerebral Angiography; D004388:Dura Mater / Q000473:pathology; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D016896:Treatment Outcome; D055815:Young Adult
keywords: Coil; Dural arteriovenous fistula; Embolization