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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Recurrence of initial angiographic occlusion in intracranial dural arteriovenous fistulas
Xin Su1,2, Yongjie Ma1,2, Huishen Pang1,2
11Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and.
Insights
Dural arteriovenous fistula (DAVF) recurrence occurs in 8.0% of patients, with risk factors including younger age and specific sinus locations. Angiographic follow-up is crucial, especially for patients with identified risk factors for DAVF.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Dural arteriovenous fistulas (DAVFs) can recur after initial treatment, with controversial risk factors.
- Understanding recurrence patterns and predictors is vital for effective management.
Purpose of the Study:
- To estimate the recurrence rate of DAVFs after angiographic cure.
- To identify factors influencing DAVF recurrence in a large patient cohort.
Main Methods:
- Retrospective analysis of the Dural Arteriovenous Fistula Research and Management in China (DREAM-INI) database.
- Inclusion of patients with initial complete cure and subsequent angiographic follow-up.
- Comparison of sustained cure versus recurrence groups, with risk factor analysis.
Main Results:
- Overall recurrence rate was 8.0% among 510 eligible patients.
- Recurrence types included new distant fistulas (48.8%) and in situ recurrence (36.6%).
- Risk factors identified: age < 45, transverse-sigmoid sinus location, multiple fistulae, pial arterial supply, venous congestion.
Conclusions:
- DAVF recurrence is linked to venous hypertension and masked fistula components.
- Younger age, specific locations, and fistula characteristics are key recurrence predictors.
- Long-term angiographic follow-up is recommended for all cured DAVF patients, especially those with risk factors.
Objective:
Recurrence after an initial angiography-determined cure of dural arteriovenous fistula (DAVF) has been reported, with risk factors identified in a few studies; however, some findings remain controversial. The objective of this study was to evaluate a large cohort of patients with DAVFs to estimate the recurrence rate and identify factors influencing recurrence.
Methods:
Patient data for this study were derived from the Dural Arteriovenous Fistula Research and Management in China (DREAM-INI) database, compiled from a single-center retrospective study conducted in China. This analysis included only patients in whom an immediate complete cure was achieved who had subsequent angiographic follow-up. Two patient groups were compared: patients in whom a sustained durable cure was achieved and those who experienced recurrence following the initial cure. In addition to comparing baseline characteristics and follow-up results, potential risk factors for recurrence were examined and a time-to-recurrence analysis was performed.
Results:
Among the 1101 patients included in the DREAM-INI dataset, 510 met the inclusion criteria for this study. Of these, 41 patients with an initially cured DAVF had 47 recurrence events; 48.8% developed new fistulas at distant sites, 36.6% had in situ recurrence, and 14.6% had both types of recurrence. The overall recurrence rate was 8.0%, with anticipated recurrence rates of 13.9% at 36 months and 24.1% at 105 months. Recurrence was more frequently observed in Borden type II DAVFs. Identified risk factors for recurrence included age < 45 years, a transverse-sigmoid sinus location, multiple fistulae, pial arterial supply, and venous congestion.
Conclusions:
DAVF recurrence can be classified as in situ recurrence and recurrence at other sites, both of which are closely linked to unresolved venous hypertension and the previously masked portion of the fistula. Risk factors for recurrence included age younger than 45 years, a transverse-sigmoid sinus location, multiple fistulae, pial arterial supply, and venous congestion. All patients with cured DAVFs, particularly those with identified risk factors, were advised to undergo angiographic follow-up beyond 1 year.
