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Review
Non-galenic arteriovenous fistulas in adults: transarterial embolization and literature review
  1. Ning Lin1,2,
  2. Adam M Brouillard1,2,
  3. Kenneth V Snyder1,2,3,4,5,
  4. Elad I Levy1,2,3,4,
  5. Adnan H Siddiqui1,2,3,4,6
  1. 1Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
  2. 2Department of Neurosurgery, Gates Vascular Institute/Kaleida Health, Buffalo, New York, USA
  3. 3Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA
  4. 4Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
  5. 5Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
  6. 6Jacobs Institute, Buffalo, New York, USA
  1. Correspondence to Dr A H Siddiqui, University at Buffalo Neurosurgery, 100 High Street, Suite B4, Buffalo, NY 14203, USA; asiddiqui{at}ubns.com

Abstract

Background Non-galenic dural arteriovenous fistula (NGAVF) is a rare congenital vascular abnormality characterized by high flow connections between cerebral arteries and a dilated pial venous varix. These lesions have been reported mostly in the pediatric population.

Objectives To examine the clinical features and treatment outcomes for adult (≥18 years) patients with NGAVFs.

Methods We retrospectively reviewed the records of patients with NGAVFs who underwent endovascular treatment between 2008 and 2013. A PubMed literature search was conducted to identify reports of adult patients with these lesions.

Results Two adults with NGAVFs were treated at our institution via transarterial embolization with a favorable outcome. The literature search revealed 24 adult NGAVF cases. Among these cases and ours, mean patient age was 33.4±13.3 years, and 13 were women. Most patients experienced protracted neurological symptoms at the time of treatment whereas 5 (19.2%) patients presented with acute hemorrhage. 18 patients had single hole fistulas; 8 had multi-hole fistulas. 11 patients were treated by microsurgical ligation, 10 by embolization, 4 by combined therapy, and 1 with observation. Two patients died of reperfusion hemorrhage. Women were more likely to have a favorable outcome than men (100% vs 75.0%; p=0.07). No statistical difference was found in terms of clinical outcome for patients with single hole versus multi-hole fistulas or those treated by surgery versus embolization.

Conclusions NGAVFs are extremely rare in the adult population and present a similar clinical course as in older children. In our experience, transarterial embolization can be safely and effectively utilized for the treatment of these lesions in adults.

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