Article Text
PDF
Abstract
Background Despite recent multi-institutional efforts, long-term data on clinical and radiological outcomes after treatment of high-grade dural arteriovenous fistulas (dAVFs) remain scarce. This study aimed to evaluate the long-term risk of hemorrhage and fistula-related mortality after treatment.
Methods Retrospective analysis of all consecutive patients primarily diagnosed with a high-grade dAVF (Cognard grade 2b, 2a+b, 3, 4) between January 2012 and September 2022 at a large neurovascular center. Primary endpoints were intracranial hemorrhage (ICH) and all-cause mortality after treatment; secondary endpoints were angiographic occlusion, complication rate and neurological deficits.
Results A total of 121 patients underwent 141 treatments (122 endovascular therapy (EVT), 5 radiotherapy, 14 surgery) of which 12 patients (10%) underwent retreatment. Follow-up was available in all patients for a median of 4.2 (IQR 2.5 to 6.6) years. Eleven patients (9%) died during the follow-up period, of which three deaths (2%) occurred after hemorrhagic presentation, one of them attributable to treatment. One death (0.8%) was due to delayed hemorrhage after partial occlusion from EVT. No other post-treatment bleedings occurred. Angiographic follow-up after multimodality treatment was available in 93% of patients after a median of 6 months; the overall occlusion rate was 90%. The overall rate of complications was 25% after EVT and 14% after surgery. The rates of new transient and permanent neurological deficits after EVT were 9% and 3%, respectively.
Conclusions The long-term rate of re-bleeding or dAVF-related mortality was low when high rates of angiographic occlusion were achieved. The risk for treatment-related complications leading to neurological sequela was low.
- Complication
- Fistula
- Hemorrhage
- Intervention
- Vascular Malformation
Data availability statement
Data within this article can be made accessible to other researchers upon reasonable request.
Statistics from Altmetric.com
Data availability statement
Data within this article can be made accessible to other researchers upon reasonable request.
Footnotes
X @rahulbrraj
Contributors TR was responsible for conceptualization, methodology, formal analysis, investigation, data curation and wrote the original draft and the revised version after the manuscript had been reviewed by all the authors. TR is guarantor. MV was responsible for formal analysis and data curation. EO and VN substantially contributed to investigation and data curation. PR and AG performed validation and AG also supervised the work. ML was responsible for formal analysis and writing. MN was responsible for validating, formal analysis, providing resources and supervision. JN contributed to methodology, validation, formal analysis, investigation, resources and supervision. RR was a main contributor as regards conceptualization, methodology, validation, formal analysis and investigation, data curation, writing, reviewing and editing at all stages and project supervision.
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 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.