Abstract Details

Title Long-Term Safety and Efficacy of Endovascular Embolization of Dural Arteriovenous Fistulas

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 104

Objective To study the long-term safety and efficacy outcomes of endovascular therapy (EVT) of dural arteriovenous fistulas (DAVFs).

Background

DAVFs are acquired pathological arteriovenous communications between meningeal arteries and dural venous sinuses or cortical veins. EVT has become the preferred choice of many centers for the treatment of DAVFs.

Design/Methods Single center retrospective cohort study of patients with DAVFs treated endovascularly between 2001 and 2017. Patient demographics, DAVF characteristics, procedure details, occlusion rates and complications were collected. Complete DAVF occlusion was defined as the absence of feeding artery shunting into sinus or cortical veins.

Results Forty-seven patients with a mean age of 56.6 years. Sixty percent were female. Venous drainage symptoms were the most common presentation (70%), and 22% had ruptured DAVFs. Transverse-sigmoid sinus (32%) was the most common DAVF location. Thirty-five patients (75%) had middle meningeal arterial feeders and 30 (64%) had cortical venous drainage. Thirty-one patients (66%) had pre-procedure MRI of which 7 (14%) showed hyperintense flair signals co-localizing with the DAVF. The mean number of embolization procedures per patient was 1.5. Trans-arterial access was the most frequent approach (67%). Onyx was the most common embolic agent (49%). Complete occlusion rate was achieved in 34 patients (72%). Eight procedural complications (17%) were observed. Mean angiographic follow-up time was 862 days in 42 patients (89%). Five (12%) DAVF recurrences and 1 (2%) de-novo fistula were observed. Clinical follow-up was available for all patients with a mean follow-up time of 1395 days. Twenty-nine patients (62%) had mRS of 0, 16 mRS of 1, 1 mRS of 2, and 1 mRS of 4. No new symptoms or hemorrhagic/ischemic complications were observed. No deaths were reported.

Conclusions EVT is safe and effective for the treatment of DAVF. Follow-up for several years after last embolization is recommended due to the AVFs recurrence rates.

Authors/Disclosures
Alan Mendez-Ruiz, MD (University of Iowa Hospitals and Clinics) PRESENTER	Dr. Mendez-Ruiz has nothing to disclose.
Mudassir Farooqui, MD	Dr. Farooqui has nothing to disclose.
	No disclosure on file
Darko E. Quispe Orozco, MD (TTUHSC-SOM, Lubbock; Neurology Dept.)	Dr. Quispe Orozco has nothing to disclose.
Kaustubh S. Limaye, MD (Indiana University School of Medicine)	Dr. Limaye has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Scientia Vascular.
Edgar Samaniego, MD, F�鶹��ýӳ�� (University of Iowa Hospital and Clinics)	Dr. Samaniego has received personal compensation for serving as an employee of University of Iowa. Dr. Samaniego has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Terumo Neuro. Dr. Samaniego has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Rapid Medical. Dr. Samaniego has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for J&J Neuro. Dr. Samaniego has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Metronic. Dr. Samaniego has received personal compensation in the range of $0-$499 for serving as a Consultant for iSchemaView. Dr. Samaniego has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Society of Neurointerventional Surgery. Dr. Samaniego has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Neurointerventional Surgery.
Santiago Ortega Gutierrez, MD (University of Iowa)	Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH. The institution of Dr. Ortega Gutierrez has received research support from PCORI.
Waldo Guerrero, MD	Dr. Guerrero has nothing to disclose.

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