Management of pediatric pial arteriovenous fistulas with a single connection: two illustrative cases
Related Experiment Video
Updated: Jun 18, 2025
Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
Published on: April 1, 2022
Matias Luis Costa1, Bryce Garrison Dennis2, Karen Chen3
1Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA matiascostamd@gmail.com.
Insights
Pediatric arteriovenous fistulas (PAVFs) are rare but can cause severe complications. This study details endovascular treatments for two high-flow PAVF cases, showcasing successful management strategies.
Area of Science:
- Pediatric Neurology
- Vascular Surgery
- Interventional Radiology
Background:
- Pediatric arteriovenous fistulas (PAVFs) are uncommon vascular malformations.
- PAVFs can lead to serious neurological and cardiovascular complications.
- Early intervention is often recommended for selected PAVF cases.
Purpose of the Study:
- To present two distinct cases of pediatric arteriovenous fistulas.
- To illustrate the endovascular treatment approaches for complex PAVFs.
- To highlight the management of single-connection, high-flow PAVFs.
Main Methods:
- Case 1: Transarterial embolization for a mid-basilar PAVF.
- Case 2: Combined transarterial and transvenous embolization for a quadrigeminal cistern PAVF.
- Detailed procedural steps and outcomes were documented.
Main Results:
- Successful endovascular treatment was achieved in both pediatric cases.
- The transarterial approach was effective for the mid-basilar PAVF.
- A multi-session approach including transarterial and transvenous routes was successful for the quadrigeminal cistern PAVF.
Conclusions:
- Endovascular techniques are effective for treating pediatric arteriovenous fistulas.
- Tailored approaches are necessary based on PAVF location and characteristics.
- These cases demonstrate the feasibility of minimally invasive management for complex PAVFs.
Abstract:
Pediatric arteriovenous fistulas (PAVFs) are rare, representing only 7.3-17.2% of all pediatric shunts.1 2 In a number of cases they can lead to life-threatening venous hypertension, hydrocephalus and macrocrania,3 heart failure,1 hemorrhagic stroke,4 5 seizures,3 and cognitive developmental issues.1-3 In selected circumstances, early and aggressive treatment is recommended.We present two cases of single-connection, high-flow PAVFs. Case 1 represents a mid-basilar PAVF treated through a transarterial approach, while case 2 represents a quadrigeminal cistern PAVF treated with several transarterial sessions followed by a final transvenous session. The procedures are shown in video 1 neurintsurg;17/11/1265/V1F1V1Video 1 Clinical cases demonstrating endovascular treatment of pediatric pial arteriovenous fistulas.
