Transarterial Balloon-Assisted Glue Embolization of Pial Arteriovenous Fistulas

Endovascular disconnection of pial arteriovenous fistulas (AVFs) is challenging. The aim of this study was to evaluate safety and effectiveness of transarterial balloon-assisted glue embolization for treating pial AVFs.

We retrospectively reviewed medical and imaging records of 8 patients with high-flow pial AVFs treated by transarterial balloon-assisted glue embolization from August 2011 to July 2017.

There were 6 male patients and 2 female patients with age range of 1-48 years. Presentation was seizure in 4 patients, headache in 3 patients, and subarachnoid hemorrhage in 1 patient. Seven lesions were located in the supratentorial region. All lesions were single-channel fistulas associated with venous varix. Five lesions had a single feeder, and 3 had multiple feeders. All lesions were obliterated completely in single-session embolization with no procedure-related complications. Two patients experienced symptomatic thrombosis of drainage venous system after embolization. One patient fully recovered on discharge, and another patient fully recovered after 8 months. With a mean clinical follow-up of 12.1 months, all patients were free of pretreatment symptoms. Follow-up angiograms revealed durable occlusion of fistulas.

Transarterial balloon-assisted glue embolization is a feasible and effective option for treatment of high-flow pial AVFs.