Clinical outcomes and rates of intraoperative and postoperative complications did not differ significantly between the groups. Better anatomic results using FD/FDs combined with coils were documented 6 months after the procedure; this option seems to provide a higher aneurysm occlusion rate and reduce the need for retreatment.

ObjectiveTentorial dural arteriovenous fistulas usually drain into cortical veins and often present with hemorrhage. Treatment goal is occlusion of the draining vein, either by surgery or endovascular techniques. We present the multimodality treatment results of 12 patients with tentorial dural arteriovenous fistulas.Materials and MethodsBetween January 2007 and January 2017, 12 consecutive patients with tentorial dural arteriovenous fistulas were treated. There were 11 men and 1 woman with a mean age of 62 years (range 44–85). Clinical presentation was hemorrhage in 8 (67%), pulsatile tinnitus in 2 (17%) and an incidental finding in 2 (17%). The fistula location was at the tentorium cerebelli in 5 (42%), the torcula Herophilii in 4 (33%) and petroclival in 3 (25%).ResultsIn 11 patients, arterial embolization with Onyx or PHIL was the primary treatment. Complete obliteration was achieved in one session in 5 (45%) and in 2 sessions in 4 (36%). In 2 patients additional surgery was needed. Primary surgery was performed in 1 patient followed by endovascular coil occlusion via the venous route. One patient with exclusive pial feeders from the posterior inferior cerebellar artery had a clinically silent P3 occlusion during trans arterial embolization. Finally, all 12 fistula were completely occluded, confirmed with angiography after 8–12 weeks. There were no permanent procedural complications.ConclusionPatients with tentorial dural arteriovenous fistulas were effectively and safely cured with a strategy of endovascular treatment with various techniques and surgery. Surgical and endovascular techniques are complementary in the treatment of these challenging vascular disorders.

Background and purpose Dural arteriovenous fistulas (DAVFs) with cortical venous drainage often present with hemorrhage or neurological deficits and prompt treatment is indicated. Disconnection of the draining vein is considered curative. We present the multimodality treatment results of 35 patients with cranial DAVFs with exclusive cortical venous drainage. Materials and methods Between January 2010 and January 2017, 35 consecutive patients with cranial dural fistulas with exclusive cortical venous drainage were treated. There were 27 men and eight women, mean age 68 years (range 45–87). Clinical presentation was hemorrhage in 23 (66%), pulsatile bruit in two (6%), seizures in one (3%) and blurred vision in one (3%). In eight patients (22%), the DAVF was an incidental finding. Location of the DAVFs was convexity in 25 (71%), posterior fossa in eight (23%) and tentorium in two (6%). Results Surgery was performed in four patients with anterior cranial fossa fistulas and in one patient with a tentorial dural fistula. In 30 patients, embolization with Onyx via the arterial route was the primary treatment with complete obliteration in one session in 25 patients. Additional surgical or endovascular sessions were necessary in five patients after incomplete embolization and in one patient after incomplete surgery. Obliteration was confirmed with angiography after three months. There were no procedural complications. Conclusions Patients with dural fistulas with cortical venous drainage were cured with a strategy of arterial endovascular treatment with Onyx and surgery. These techniques were either primarily successful or complementary. There were no complications of treatment.

Tibio-peroneal trunk (TPT) lesions are usually categorized as ‘complex’ in anatomical classifications, which leads to the perception that endovascular therapy (EVT) will be challenging and the outcome most likely poor. This multicenter, retrospective cohort study investigates the efficacy of the EVT of TPT lesions in patients with chronic limb threatening ischemia (CLTI) or an infrapopliteal bypass at risk. The primary endpoint was limb-salvage. The secondary outcomes were technical success, freedom from clinically driven target lesion revascularization (CD-TLR), overall survival, and amputation-free survival. A total of 107 TPT lesions were treated in 101 patients. At 3 years, the limb-salvage rate was 76.4% (95% CI 66.0–86.8%). Technical success was achieved in 96.3% of cases. The freedom from CD-TLR, amputation-free survival, and overall survival at 3 years were 53.0% (95% CI 38.1–67.9%), 33.6% (95% CI 23.0–44.2%), and 47.7% (95% CI 36.1–59.3%), respectively. Reintervention significantly increased the hazard ratio for amputation by 7.65 (95% CI 2.50–23.44, p < 0.001). Our results show that the EVT of both isolated and complex TPT lesions is associated with high technical success and acceptable limb-salvage rates, with reintervention being a major risk factor for amputation. Moreover, mid-term mortality rate was relatively high. In future revisions of the anatomical grading scales, the classification of TPT lesions as highly complex should be reconsidered.