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'Balloon pressure technique' for endovascular treatment of spinal cord arteriovenous fistulas: preliminary results in 10 cases
  1. Frédéric Clarençon1,
  2. Damien Parat1,
  3. Eimad Shotar1,
  4. Kévin Premat1,
  5. Stéphanie Lenck1,
  6. Mehdi Drir2,
  7. Elisabeth Maillart3,
  8. Anne-Laure Boch4,
  9. Nader Sourour1
  1. 1Interventional Neuroradiology, APHP-Sorbonne University. Pitié-Salpêtrière Hospital, Paris, France
  2. 2Anesthesiology, APHP-Sorbonne University. Pitié-Salpêtrière Hospital, Paris, France
  3. 3Neurology, APHP-Sorbonne University, Pitié-Salpêtrière Hospital, Paris, Île-de-France, France
  4. 4Neurosurgery, APHP-Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
  1. Correspondence to Professor Frédéric Clarençon, Interventional Neuroradiology, University Hospital Pitié Salpêtrière, 47, Bd de l'Hôpital. 75013, Paris, France; fredclare5{at}


Background Spinal arteriovenous fistulas (SAVFs) are challenging lesions to treat by endovascular means. Our purpose was to report our early experience with dual lumen balloons (DLBs) for embolization of SAVFs using ethylene vinyl alcohol (EVOH) (the so-called 'balloon pressure technique' (BPT)).

Materials and methods During the inclusion period, 10 consecutive patients (nine men, mean age 61.6 years) underwent endovascular treatment of a SAVF (seven dural SAVFs and three epidural SAVFs) at a single institution using the BPT. DLBs were used in all cases. In seven cases (70%), a regular DLB was used, while in three cases (30%), low profile DLBs were used. EVOH was used as the liquid embolic agent in all cases. Technical and clinical complications were systematically recorded. Clinical and angiographic outcomes were systematically evaluated more than 3 months after the procedure.

Results Complete cure of the SAVF by endovascular means alone was obtained in 80% of cases (8/10). For the two patients with incomplete SAVF occlusion, surgery was successfully performed secondarily. No recurrence was found at the 3 month follow-up in the eight patients for whom complete occlusion was obtained at the end of the embolization procedure. No permanent clinical complication was recorded using the BPT. Clinical improvement was observed in 6/10 (60%) cases.

Conclusion BPT was a feasible technique, with regular or low profile DLBs, for embolization of SAVFs. Our preliminary results suggest the safety and effectiveness of this technique.

  • Vascular Malformation
  • Spinal cord
  • Arteriovenous Malformation
  • Balloon

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  • Contributors FC: conception of the study and manuscript writing. DP, ES, and KP: data acquisition and critical review of the manuscript. SL, MD, EM, A-LB, and NS: critical review of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests FC reports conflicts of interest with Medtronic, Guerbet, Balt Extrusion, and Penumbra (payment for readings; not related to the study), and Codman Neurovascular and Microvention (core lab; not related to the study). NS is a consultant for Medtronic, Balt Extrusion, and Microvention.

  • 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.