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Original research
Clinical features and outcomes of perimedullary arteriovenous fistulas: comparison between micro- and macro-type lesions
  1. Jiaxing Yu1,2,
  2. Shiju Zhang1,2,
  3. Lisong Bian3,
  4. Chuan He1,2,
  5. Ming Ye1,2,
  6. Guilin Li1,2,
  7. Peng Hu1,2,
  8. Liyong Sun1,2,
  9. Feng Ling1,2,
  10. Hongqi Zhang1,2,
  11. Tao Hong1,2
  1. 1 Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
  2. 2 China International Neuroscience Institute (China-INI), Beijing, China
  3. 3 Beijing Haidian Hospital, Beijing, China
  1. Correspondence to Dr Tao Hong; 2030921{at}; Dr Hongqi Zhang; xwzhanghq{at}


Background Although the angioarchitecture of perimedullary arteriovenous fistulas (PMAVFs) is straightforward, their size and blood flow are highly heterogeneous. This study aimed to evaluate the differences in clinical features and outcomes of PMAVFs based on lesion size and blood flow.

Methods 114 consecutive patients with PMAVFs from two institutes were retrospectively reviewed. The lesions were classified as either micro-PMAVFs (shunt point diameter <1 cm) or macro-PMAVFs (shunt point diameter ≥1 cm).

Results The patients with micro-PMAVFs were older at the first presentation (33.50 vs 13.50 years, p<0.001). Macro-PMAVFs were more commonly associated with spinal metameric arteriovenous shunts (6.9% vs 28.6%, p=0.003). Compared with the macro-PMAVFs, the micro-PMAVFs showed a significantly higher risk of gradual clinical deterioration after initial onset (73.6%/year vs 10.0%/year; HR 3.888, 95% CI 1.802 to 8.390, p=0.001). A total of 58.6% of the micro-PMAVFs were treated surgically, whereas 85.7% of the macro-PMAVFs were treated via endovascular approaches. Complete obliteration was 73.7% for the whole cohort, and was more common for the micro-PMAVFs than for the macro-PMAVFs (87.9% vs 58.9%, p=0.001). At the last follow-up, spinal function was significantly improved compared with the pretreatment status, and the rate of severe disability of patients with macro-PMAVFs was slightly but not significantly higher than that of patients with micro-PMAVFs (16.1% vs 8.6%, p=0.315)

Conclusions The clinical risks, treatment strategies and obliteration rates of PMAVFs differ based on their size and blood flow.

  • Spinal cord
  • Hemorrhage
  • Fistula

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • JY, SZ and LB are joint first authors.

  • HZ and TH contributed equally.

  • JY, SZ and LB contributed equally.

  • Contributors In addition to the guarantors of this work (Tao Hong and Hongqi Zhang), all authors were involved and made substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of the data; drafting the work or revising it critically for important intellectual content; final approval of the version published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This work was supported by the National Natural Science Foundation of China (81971113, 81971104, 81671202, 82122020), Beijing Municipal Science and Technology Commission with grant D161100003816001, Beijing Municipal Education Commission with grant CIT&TCD201904095 and Beijing Municipal Administration of Hospitals with grant DFL20180801 and QML20190802.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.