Clinical outcomes of intracranial dural arteriovenous fistulas with the pseudophlebitic pattern

A pseudophlebitic pattern (PPP) is now widely recognized as an angiographic manifestation of chronic venous congestion in intracranial dural arteriovenous fistulas (DAVFs).

To investigate the association between a PPP and chronic venous congestion in patients with intracranial DAVFs.

We retrospectively reviewed consecutive patients evaluated over a 21-year period. Angiographic studies were assessed for the presence of PPP, which was defined as serpiginous and tortuous collateral, bridging, and cortical veins with delayed circulation time in the normal brain. Baseline characteristics and follow-up outcomes were compared between patients with DAVF with and without PPP. To reduce selection bias, the two cohorts were matched in a 1:1 ratio using propensity score matching.

PPP was found in 256 patients (23.3%). In the unmatched cohort, patients with DAVF with PPP showed lower occlusion rates on angiographic follow-up (73.6% vs 92.7%, P<0.001), higher mRS scores at clinical follow-up (P<0.001), reduced proportions of excellent (79.2% vs 88.1%, P<0.001) and good outcomes (69.7% vs 81.5%, P<0.001), as well as increased all-cause mortality (10.9% vs 4.9%, P=0.001). After matching for baseline characteristics and occlusion status, no significant differences in clinical outcomes were observed between patients with DAVF with and without PPP in the entire cohort, the high-grade cohort, or the cohort limited to PPP-relevant locations.

PPP alone is not sufficient as an independent prognostic marker for DAVF. Future studies should aim to develop more comprehensive scoring systems that incorporate detailed angioarchitectural characteristics to enhance prognostic stratification.