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* Date : 06-08-2009 - 07:40 PM (285 days ago), * Characters : 1330, Words : 197, Size : 1.30 Kb.

Transarterial Coil Embolization of the Venous Component of Aggressive Type 4 Dural Arteriovenous Fistulas.

Tokunaga et al.5 described a single case of transarterial coil embolization of a venous pouch in a dAVF. That previously reported case was a benign dAVF in which the fistula was located relatively proximally along the posterior division of the middle meningeal artery. The fistula locations in our 2 cases required extremely distal access within the middle meningeal arteries. Achieving such distal access may be related to advances in microcatheters and may become more common in the future.

These 2 cases represent the feasibility of performing coil embolization of the venous outlet of dAVFs from a transarterial approach. In selected cases, this technique may offer substantial advantages over other endovascular approaches. In lesions where the morphology of the venous outlet precludes retrograde, transvenous coil embolization, transarterial particulate or glue embolization might be considered; however, particulate embolization is unlikely to effect a cure. Glue embolization may cure such lesions, but achieving glue deposition into the venous outlet may be technically challenging, in light of the uncontrolled nature of glue deposition. Transarterial coil occlusion of the venous outlet, as in the 2 cases described here, offers a highly controlled, safe alternative to glue embolization and still achieves a cure.

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