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Case series
The dual microcatheter technique for transvenous embolization of dural arteriovenous fistulae
  1. Isaac Josh Abecassis1,
  2. John D Nerva1,
  3. Basavaraj V Ghodke1,2,
  4. Laligam N Sekhar1,2,
  5. Michael R Levitt1,2,3,
  6. Louis J Kim1,2
  1. 1Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
  2. 2Department of Radiology, University of Washington, Seattle, Washington, USA
  3. 3Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Louis J Kim, c/o Neuroscience Publications; University of Washington, Box 359924, 325 9th Ave, Seattle, WA 98104, USA; publications{at}


Background Dural arteriovenous fistulae (dAVFs) comprise 10–15% of all intracranial arteriovenous malformations. The goal of surgical or endovascular intervention is complete obliteration of the fistulous connection(s). In cases where dAVF venous drainage is separate from normal cortical drainage, transvenous embolization can provide fast and effective fistula obliteration.

Objective To describe a new method of efficient transvenous embolization (the ‘dual microcatheter technique’) for the treatment of dAVFs.

Methods Three patients with dAVFs were treated using the dual microcatheter technique for transvenous embolization. Two microcatheters were placed in the distal aspect of the dAVF venous pouch, after which coil embolization reduced fistula flow, and liquid embolic agent injection with reflux into arterial feeders completed the obliteration of the fistula.

Results Lesion grade ranged from Borden–Shucart grades 2 through 3. In all cases, dAVF venous drainage was isolated from the normal cerebral venous drainage. Dual microcatheter transvenous embolization was successful in all patients, with non-target embolization and no new postoperative deficits. At the last follow-up, all three patients were symptom-free without evidence of radiographic recurrence.

Conclusions The dual microcatheter technique of transvenous dAVF embolization is safe and feasible in cases where dAVF venous outflow is isolated from normal cerebral venous drainage.

  • Vascular Malformation
  • Technique
  • Fistula
  • Catheter
  • Arteriovenous Malformation

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  • Contributors All authors made significant contributions to the conception, design, implementation, data collection and analysis, and drafting of the manuscript. IJA and JDN contributed to the acquisition and analysis of the data as well as drafting and critically revising the manuscript. BVG, LNS, and LJK contributed to the conception and design. MRL contributed to the conception and design as well as drafting and critically revising the manuscript.

  • Competing interests None declared.

  • Ethics approval Ethics approval was received from the authors' institutional review board.

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