Endovascular treatment of spinal dural arteriovenous fistulas with multiple segment catheterization approach

Endovascular treatment has increasingly become the first-line treatment for spinal dural arteriovenous fistulas (SDAVFs); however, problems of lower initial complete occlusion rates compared with surgery remain unresolved.

To evaluate multiple segment catheterization transarterial embolization (TAE) for SDAVFs.

A retrospective review of patients with SDAVFs and spinal extradural arteriovenous fistula treated with TAE between April 2009 and March 2024, was conducted. Clinical and radiographic data were analyzed to compare TAE using multiple segment catheterization with conventional TAE.

Among 32 patients treated by TAE, 17 had multiple segment feeders. Of these, eight patients were treated with conventional TAE, while nine underwent multiple segment catheterization TAE. The complete occlusion rate immediately after the procedure was significantly higher in the multiple segment catheterization TAE group (100% vs 50%; P=0.001). No patient in the multiple segment catheterization TAE group required additional treatment (P=0.02). Among the four patients in the conventional TAE group in whom fistula occlusion was incomplete, one underwent a second embolization, two underwent surgery, and one refused further treatment. Re-treatment resulted in complete occlusion in the one embolization and in the two surgery cases. Therefore, overall complete occlusion at last follow-up was achieved in 16/17 (94%) patients. Late neurological deterioration and recurrence occurred in one patient in the conventional TAE group.

Multiple segment catheterization TAE allowed precise intraoperative assessment of angioarchitecture and resulted in a significantly higher occlusion rate than conventional TAE without increasing complications.