Background Transvenous (TV) embolization is ideal for endovascular treatment of intracranial dural arteriovenous fistulas (DAVF). However, it is not always feasible because of various factors, and transarterial (TA) embolization could then be tried.

Objective We aimed to determine the incidence of ‘distally enlarged feeding artery phenomenon’ and the major feeding artery in DAVF. In case TV approach is difficult and this phenomenon observed, we could use this vessel for transarterial intravenous (TAIV) embolization as an endovascular treatment modality for DAVF.

Methods Forty-four patients with intracranial DAVF treated using endovascular procedure between 2009 and 2016 were retrospectively reviewed. Their clinical records, angiography reports, embolization procedure notes were studied and their angiographies were chronologically classified into proliferative and restrictive types.

Results In 14 of 44 patients (32%), we observed the ‘distally enlarged feeding artery phenomenon.’ The most common enlarged artery was the middle meningeal artery. The distally enlarged feeding artery group was predominantly the restrictive type, while the other group was proliferative in nature. Of the 14 cases, seven patients underwent TAIV embolization, while the other seven underwent TV embolization.

Disclosures D. Shim: None. Y. Kim: None. S. Baik: None.