Division of Interventional Neuroradiology, Department of Radiology, Mahidol University, Ramathibodi Hospital Medical School, Pyathai, Bangkok, Thailand.
AJNR Am J Neuroradiol. 2011 Oct;32(9):1738-44. doi: 10.3174/ajnr.A2566. Epub 2011 Jul 28.
DAVFs with cortical venous reflux carry a high risk of morbidity and mortality. Endovascular treatment options include transarterial embolization with a liquid embolic agent or transvenous access with occlusion of the involved venous segment, which may prove difficult if the venous access route is thrombosed. The aim of this article is to describe the technique and results of the transvenous approach via thrombosed venous segments for occlusion of DAVFs.
Our study was a retrospective analysis of 51 patients treated with a transvenous approach through an occluded sinus that was reopened by gentle rotational advancement of a 0.035-inch guidewire, which opened a path for a subsequently inserted microcatheter.
Of 607 patients with DAVFs, the transvenous reopening technique was attempted in 62 patients in 65 sessions and was successful in 51 patients and 53 sessions. Immediate occlusion was seen in 42 patients; on follow-up, occlusion was seen in 49 patients, whereas 2 patients had reduced flow without cortical venous reflux. No permanent procedure-related morbidity was noted.
The reopening technique to gain access to isolated venous pouches or the cavernous sinus for the treatment of DAVFs is a safe and effective treatment, which should be considered if transarterial approaches fail or are anticipated to result only in an incomplete anatomic cure.
具有皮质静脉回流的 DAVF 具有较高的发病率和死亡率。血管内治疗方案包括经动脉栓塞术，使用液体栓塞剂，或经静脉入路闭塞受累静脉段，如果静脉入路血栓形成，可能难以实施。本文旨在描述经静脉入路闭塞 DAVF 中通过血栓形成的静脉段的技术和结果。
我们的研究是对 51 例经闭塞窦再通的患者进行回顾性分析，通过轻柔旋转推进 0.035 英寸的导丝再通窦，为随后插入的微导管开辟了一条通路。
在 607 例 DAVF 患者中，有 62 例患者在 65 次治疗中尝试了经静脉再通技术，51 例患者和 53 次治疗中获得成功。42 例患者即刻闭塞，随访时 49 例患者闭塞，2 例患者皮质静脉回流减少但无血流。无永久性与操作相关的并发症。
如果经动脉入路治疗失败或预计仅能达到不完全解剖治愈，那么为了治疗 DAVF 而重新进入孤立的静脉袋或海绵窦的再通技术是一种安全有效的治疗方法，应该考虑使用。
