Background and Purpose The identification of sacral dural arteriovenous fistulas (DAVFs) can be challenging. We sought to review our experience, and the published literature, for the arterial supply and venous drainage of sacral DAVFs.
Methods We retrospectively reviewed our electronic medical record for patients with sacral DAVFs diagnosed at our institution. Catheter angiograms were reviewed for arterial supply and venous drainage. We reviewed the published literature for this information as well.
Results We identified three patients with sacral DAVFs diagnosed on catheter angiography between January 2016 and November 2022. One arose at S1 and the other two at S2. One (figure 1 - at S1) was supplied by the median sacral artery (MSA). The remaining two were supplied by branches of the lateral sacral artery (LSA). All three drained into the Filum Terminale Vein (FTV) before anastamosis with the coronal venous plexus of the cord. Published reports limit the supply of sacral DAVFs to the MSA, the LSA or the Iliolumbalis artery (ILA). All drained via the FTV.
Conclusions 1. A dilated FTV on cross-sectional imaging in a patient with a suspected spinal DAVF should raise suspicion for a sacral origin. 2. Selective injections of the MSA, LSA and ILA should be performed in the hunt for a spinal DAVF.
Disclosures E. Fuller: None. M. Hayakawa: None. K. Dlouhy: None. S. Ortega: None. E. Samaniego: None. C. Derdeyn: 2; C; Penumbra, Microvention, Silk Road, NoNO. 4; C; Pulse Therapeutics.
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