Balloon protection of the Labbé vein during transarterial embolization of a dural arterio-venous fistula

Abstract

<jats:sec><jats:title>Introduction</jats:title><jats:p> Endovascular treatment of type III dural arterio-venous fistulas can be challenging if the fistulous point is close to a functionally important cortical vein. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A technique is described for temporary balloon protection of the vein of Labbé during transarterial Onyx embolization of a type III dural arterio-venous fistula. One illustrative case is presented. Careful anatomic consideration of the concerned venous segment (at the insertion point into the lateral sinus) and the choice of balloon minimized the risk of venous rupture. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Using this method, satisfactory progression of Onyx was obtained within the arterio-venous shunt while preserving the patency of the Labbé vein. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Temporary balloon protection of the Labbé vein is a feasible option to preserve its patency during embolization of dural arterio-venous fistulas. To the authors’ knowledge, this is the first report on the use of temporary balloon protection of a cortical vein. </jats:p></jats:sec>

Balloon protection of the vein of Labbé during embolisation of a dural arteriovenous fistula

“…A 2015 technical note reports the use of a single-lumen balloon-catheter in the VL during treatment of a dAVF 5. Our case is the first report describing VL protection using a compliant dual-lumen balloon-catheter during embolisation of a dAVF.…”

“…Use of balloons to protect the patency of dural sinuses during transarterial embolisation was initially described in 2008 (oral communication by René Chapot, MD during the Val d’Isère ABC-WIN Seminar in France) 5. Other reports have further documented the technique’s safety and efficacy 4 6 7…”

Current status of endovascular treatment for dural arteriovenous fistula of the transverse-sigmoid sinus: A literature review

“…In the technique, it is important to identify collateral venous drainage, and any balloon position with an appearance of normal venous outflow stagnation should be avoided. Moreover, temporary deflations of the balloon (normally within 3-5 min) are usually performed during the pauses of Onyx ® injection to allow temporary drainage of the normal venous path, especially in the dominant sinus or in cases involving normal cortical arteries 13, 21, 66, 82, 85.…”

“…During the Onyx ® tunnel technique, it is important to protect the vein of Labbé using an additional balloon, but protecting the vein may not always be necessary because it may not be needed for normal venous drainage 41, 85. However, the preservation of functionally dependent veins is essential to avoid venous infarction or hemorrhage.…”