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Updated: Feb 24, 2026
Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
Published on: April 1, 2022
Study and therapeutic progress on spinal cord perimedullary arteriovenous fistulas
Tiefeng Ji1, Yunbao Guo2, Lei Shi2
1Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.
Abstract:
Spinal cord perimedullary arteriovenous fistulas (PMAVFs) are rare and belong to type IV spinal cord arteriovenous malformations (AVMs). Little is known regarding the treatment and prognosis of spinal cord PMAVFs. In the present study the relevant literature from PubMed was reviewed, and it was found that these fistulas can occur at all ages but are more common in children. In children, most spinal cord PMAVFs are large and with high flow, begin with bleeding and are frequently associated with hereditary hemorrhagic telangiectasia. However, in adults, most spinal cord PMAVFs are small and with low flow and begin with progressive spinal cord dysfunction. The early diagnosis of spinal cord PMAVFs is generally difficult, and symptoms can be very severe at the time of diagnosis. Digital subtraction angiography remains the gold standard; however, computed tomography angiography and magnetic resonance angiography are also promising. Spinal cord PMAVFs can be treated by endovascular embolization, surgical removal or a combination of the two methods. Most spinal cord PMAVFs show good outcomes after the appropriate treatment, and the prognosis is primarily associated with the blood flow of the PMAVF. For high-flow spinal cord PMAVFs, endovascular embolization is more effective and can lead to a good outcome; however, for low-flow spinal cord PMAVFs, surgical removal or the combination with endovascular embolization is the optimal choice. The prognosis for low-flow types is slightly worse than for high-flow spinal cord PMAVFs in children, but the outcome is acceptable.
Insights
Spinal cord perimedullary arteriovenous fistulas (PMAVFs) are rare but treatable. Treatment and outcomes depend on fistula flow rate, with high-flow types benefiting from embolization and low-flow types from surgery or combined approaches.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Spinal cord perimedullary arteriovenous fistulas (PMAVFs) are rare Type IV spinal cord arteriovenous malformations.
- Limited knowledge exists regarding their treatment and prognosis.
- PMAVFs present differently in children (large, high-flow, bleeding, associated with hereditary hemorrhagic telangiectasia) versus adults (small, low-flow, progressive dysfunction).
Purpose of the Study:
- To review the literature on spinal cord PMAVFs.
- To understand the characteristics, diagnosis, treatment, and prognosis of PMAVFs.
- To provide guidance on optimal treatment strategies based on fistula characteristics.
Main Methods:
- Comprehensive literature review of PubMed.
- Analysis of patient demographics, clinical presentation, diagnostic modalities, treatment options, and outcomes.
- Categorization of PMAVFs based on flow rate (high vs. low) and age group.
Main Results:
- PMAVFs occur across all ages, more frequently in children.
- Diagnosis can be challenging due to severe initial symptoms.
- Digital subtraction angiography is the gold standard, with CT and MR angiography as promising alternatives.
- Endovascular embolization, surgical removal, or combined methods are treatment options.
- High-flow PMAVFs generally have good outcomes with embolization.
- Low-flow PMAVFs are best treated with surgery or combined therapy.
- Prognosis is linked to flow rate, with low-flow types having a slightly worse but acceptable outcome.
Conclusions:
- Spinal cord PMAVFs require tailored treatment based on flow characteristics.
- Early diagnosis and appropriate intervention lead to favorable outcomes.
- Endovascular embolization is effective for high-flow PMAVFs, while surgery or combined approaches are optimal for low-flow types.
