INTERVENTIONAL RADIOLOGY / ORIGINAL PAPER
Endovascular embolization of dural arteriovenous fistulas: an 8-year single-centre experience and comparison with contemporary literature
1
Aga Khan University Hospital, Karachi, Pakistan
These authors had equal contribution to this work
Submission date: 2025-03-29
Final revision date: 2025-08-11
Acceptance date: 2025-09-03
Publication date: 2025-12-05
Corresponding author
Abdur Rehman
Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan, Karachi, Pakistan
Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan, Karachi, Pakistan
Pol J Radiol, 2025; 90: 591-601
KEYWORDS
TOPICS
ABSTRACT
Purpose:
Dural arteriovenous fistulas (DAVFs) are complex vascular malformations characterised by abnormal communications between the meningeal arteries and dural venous sinuses or cortical veins. They may be associated with underlying thrombotic associations such as the presence of cerebral venous sinus thrombosis (CVST) or transversesigmoid sinus (TSS) occlusion, which can affect prognostic outcomes. Additionally, the types of DAVFs may also have varying clinical and technical outcomes.
Material and methods:
This study was a retrospective cohort analysis conducted on 27 DAVF patients from 2015 to 2023 who presented at Aga Khan University Hospital, Karachi. We examined the fistula types, clinical and technical success rates, complications, recurrence and the presence of concurrent CVST or TSS.
Results:
Complete clinical and technical success rates were 44% and 63%, respectively. The rates of complications and recurrence were 18.5% and 19%, respectively. The presence of thrombotic associations (CVST and TSS occlusion) was associated with significantly lower clinical success rates in our cohort. Type II Cognard fistulas were significantly associated with the presence of CVST and TSS occlusion (p = 0.003 and p = 0.044 respectively) as well as lower clinical success as compared to type IV fistulas.
Conclusions:
Our findings advocate for comprehensive recognition of thrombotic associations of DAVFs and their potential integration into classification systems to better determine prognostic outcomes. Large-scale multi-centre studies are required to validate these associations further and guide treatment strategies.
Dural arteriovenous fistulas (DAVFs) are complex vascular malformations characterised by abnormal communications between the meningeal arteries and dural venous sinuses or cortical veins. They may be associated with underlying thrombotic associations such as the presence of cerebral venous sinus thrombosis (CVST) or transversesigmoid sinus (TSS) occlusion, which can affect prognostic outcomes. Additionally, the types of DAVFs may also have varying clinical and technical outcomes.
Material and methods:
This study was a retrospective cohort analysis conducted on 27 DAVF patients from 2015 to 2023 who presented at Aga Khan University Hospital, Karachi. We examined the fistula types, clinical and technical success rates, complications, recurrence and the presence of concurrent CVST or TSS.
Results:
Complete clinical and technical success rates were 44% and 63%, respectively. The rates of complications and recurrence were 18.5% and 19%, respectively. The presence of thrombotic associations (CVST and TSS occlusion) was associated with significantly lower clinical success rates in our cohort. Type II Cognard fistulas were significantly associated with the presence of CVST and TSS occlusion (p = 0.003 and p = 0.044 respectively) as well as lower clinical success as compared to type IV fistulas.
Conclusions:
Our findings advocate for comprehensive recognition of thrombotic associations of DAVFs and their potential integration into classification systems to better determine prognostic outcomes. Large-scale multi-centre studies are required to validate these associations further and guide treatment strategies.
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