Spontaneous closure of a dural arteriovenous fistula

Abstract

Spontaneous closure of a dural arteriovenous fistula (dAVF) is a rare condition and only a few cases have been reported since its first description in 1976. We report delayed and progressive spontaneous closure of a dAVF after massive intracerebral hemorrhage documented by angiographic studies before and after bleeding. To our knowledge, this is the first report to document gradual closure of a dAVF by serial angiographic studies. The mechanism of spontaneous closure of dAVFs has not been fully elucidated. We suggest different factors for consideration from previously published data and show how each of these factors can influence the others.

Spontaneous closure of a superior sagittal sinus dural arteriovenous fistula with an extensive angioarchitectural network: A case report and systematic review of the literature

“…[ 21 ] From the results of our systematic review, 12 other cases also posit a similar mechanism as the sole or primary factor behind the disappearance of their respective DAVFs. [ 3 , 8 , 14 , 16 , 17 , 24 , 25 , 28 , 30 ] In a report by Kannath et al .,[ 14 ] the authors speculated that DAVFs with sparse angioarchitectural networks were associated with spontaneous thrombosis and regression of DAVFs; similarly, Voormolen et al . [ 30 ] posited that small fistulas with single draining veins were more susceptible to venous outflow obstruction and subsequent lesion thrombosis.…”

“…From our systematic review, the two main suggested mechanisms involve either direct endothelial injury and endoluminal stasis induced by neurosurgical intervention or thrombogenic effects of contrast medium during imaging. [ 2 , 3 , 7 , 10 , 16 , 26 , 28 , 30 ] A prototypical case reported by AlAfif et al . [ 3 ] documented both mechanisms in conjunction leading to the regression of the DAVF in their case: hematoma evacuation led to hemodynamic changes and partial closure of DAVF feeders, and subsequent follow-up angiographs contributed to chronic thrombosis and eventual regression.…”

“…[ 2 , 3 , 7 , 10 , 16 , 26 , 28 , 30 ] A prototypical case reported by AlAfif et al . [ 3 ] documented both mechanisms in conjunction leading to the regression of the DAVF in their case: hematoma evacuation led to hemodynamic changes and partial closure of DAVF feeders, and subsequent follow-up angiographs contributed to chronic thrombosis and eventual regression. Selective catheterization of feeding arteries with resultant blood flow stagnation and endothelial damage during angiography[ 2 , 3 , 30 ] or attempted endovascular intervention[ 10 ] have also been cited as potential precipitators of DAVF closure.…”

Spontaneous Regression of a Large High-Flow Intracranial Dural Arteriovenous Fistula

“…If hematoma occurs and causes mass effect, the resulting compression on the feeding arteries could also explain the spontaneous resolution [4]. Recently, the gradual closure of a DAVF after a large intracerebral hemorrhage was documented by serial angiograms [5]. Contrast media given during digital subtraction angiography (DSA) can affect the endothelium of the feeding arteries and has been proposed as another possible explanation [6,7], though in high-flow lesions, the first-pass dwell time of contrast on the endothelium is minimal.…”

Factors Predicting Spontaneous Thrombosis of Aggressive Cranial Dural Arteriovenous Fistulas

“…13 Pathological studies have demonstrated the expression of various vascular growth factors such as vascular endothelial growth factor in the dural layer and these factors may play a crucial role in the development of DAVF, especially in the setting of venous hypertension. 23,24 Beyond angiogenesis, vascular endothelial growth factor induces tissue factor, a major procoagulant which activates coagulation cascade and promotes fibrin deposition in the vessel wall.…”