Precision Diagnosis and Targeted Interventional Strategies in Spinal Epidural Arteriovenous Fistulas

Spinal epidural arteriovenous fistulas (SEDAVFs) are rare vascular anomalies that can cause venous hypertension and progressive neurological deficits. Current diagnostic challenges include anatomical complexity (e.g., multishunt systems) and limitations of noninvasive imaging. This study evaluates the efficacy of high-resolution spinal digital subtraction angiography (DSA) and endovascular embolization in optimizing diagnosis and treatment outcomes.

A retrospective analysis of 10 SEDAVF patients (2010-2024) was conducted. Inclusion criteria required DSA-confirmed diagnosis and complete preservation of data. Clinical data, imaging (magnetic resonance imaging/magnetic resonance angiography, digital subtraction angiography.), and treatment data (endovascular embolization with Onyx/coils were analyzed. Outcomes included neurological improvement (Aminoff and Logue Score, modified Rankin Scale), occlusion rates, complications, and recurrence.

DSA identified multifeeder systems in 70% (7/10) of cases, predominantly at thoracolumbar levels (T11-L2). Endovascular embolization achieved 100% technical success (10/10), with complete fistula occlusion and no major complications. Post-treatment, 90% (9/10) exhibited neurological improvement (≥1-point modified Rankin Scale reduction), and sphincter dysfunction resolved in 80% (4/5). One recurrence (10%) occurred at 3 months, which was successfully retreated. Median follow-up was 18.4 months (range: 1-37).

High-resolution DSA is critical for precise SEDAVF localization, particularly in multishunt systems. Endovascular embolization is a highly effective treatment modality for SEDAVFs.