Spontaneous Closure of Cerebral Dural Arteriovenous Fistulas with Direct Cortical Venous Drainage

Voormolen, Maurits; Geens, K.; Hauwe, Luc van den; Parizel, Paul M.

doi:10.1177/159101990901500316

Cited by 20 publications

(16 citation statements)

References 14 publications

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“…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. It has been suggested that a distinction for spontaneous closure be made between spontaneous DAVFs and post-traumatic DAVFs [8], with spontaneous DAVFs being more likely to close without treatment.…”

Section: Discussionmentioning

confidence: 99%

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

Aj¹

2017

Austin J Cerebrovasc Dis & Stroke

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Dural arteriovenous fistulas (DAVFs) are vascular anomalies that form a connection between meningeal vessels and dural venous sinuses or cortical veins. A 47-year-old female with a history of rheumatoid arthritis and hypercoagulable state treated with warfarin was found to have a large transverse sinus DAVF with high-flow fast arteriovenous shunting. Her initial diagnostic angiogram performed at an outside institution clearly showed the large DAVF. Eight months later, a second diagnostic angiogram demonstrated that her DAVF had spontaneously resolved. Spontaneous regression of a DAVF is rare, and this is the largest DAVF that our institution has seen to resolve on its own. DAVFs have previously been known to spontaneously resolve, but few cases have been reported since it was first described in 1976. The mechanism for spontaneous closure is unknown, but several different mechanisms have been proposed. We postulate that spontaneous regression in this patient is related to her underlying hypercoagulable state and the high-flow nature of the DAVF. High-flow DAVFs can resolve spontaneously, and cautious modification of anticoagulation in select patients in order to induce fistula thrombosis may provide an avenue of management to consider. Her past medical history is significant for rheumatoid arthritis and the above-mentioned hypercoagulable state, as well as a remote history of several DVTs. She has no history of smoking, other tobacco use, alcohol use, or illicit drug use. Her brother is also noted to have a hypercoagulable state.Although the patient was prescribed a low molecular weight heparin bridge between her usual warfarin and the time of angiography at our institution, that prescription was not filled. Thus, the patient's warfarin was stopped four days prior to her procedure with no anticoagulant bridging. Upon presentation to our institution, Case PresentationIntracranial dural arteriovenous fistulas (DAVFs) are rare vascular malformations that connect meningeal arteries to dural venous sinuses or cortical veins. They were originally believed to be benign lesions compared to pial arteriovenous malformations (AVMs) until intracranial hemorrhage from a DAVF was observed [1]. Although hemorrhage from ruptured cortical venous varices is the most serious and worrisome complication, DAVFs can present with a variety of symptoms, including headaches, seizures, pulsatile tinnitus, and vision disturbances. Few DAVFs have been reported to resolve spontaneously since the phenomenon was first described in 1976 [2]. The reason for spontaneous closure is largely unknown, although several mechanisms have been proposed. In this report, we describe a case of spontaneous resolution of a large DAVF in a patient with a hypercoagulable state.A 47-year-old female was seen at an outside institution and found to have a large transverse sinus DAVF with high-flow fast arteriovenous shunting. One year prior to discovery of the DAVF, she underwent work-up at an outside institution for a seven-year history of daily occipital he...

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Section: Discussionmentioning

confidence: 99%

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

Aj¹

2017

Austin J Cerebrovasc Dis & Stroke

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“…Spontaneous closure of dAVFs after angiography can be identified as a distinct mechanism 3 8. Five spontaneous closures supposed to be related to cerebral angiography have been described in the literature.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous closure of a dural arteriovenous fistula

Al-Afif

Nakamura

Götz

et al. 2014

J NeuroIntervent Surg

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SUMMARYSpontaneous 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. BACKGROUND

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“…These included presence of intracranial bleed, draining vein thrombosis, sinus recanalization, intrinsic compression on the DAVF, post traumatic etiology, contrast medium induced thrombosis and slow flow. [1][2][3][4][5][6][7] Objective characteristics such parenchymal bleed, stenosis of the feeding artery, draining vein thrombosis and sinus recanalization were evaluated from the serial angiographic and imaging studies. Besides these parameters, additional features of DAVF such as the architectural characteristics of the fistulous network, transit time of fistula flow, impedance to fistula drainage, anatomical extent of DAVF were defined for comparative analysis and reduction of reporting bias.…”

Section: Imaging and Angiographic Assessmentmentioning

confidence: 99%

“…This effect might be further compounded by the temporary stagnation of flow following selective cannulation of small feeding arteries. 3 Nevertheless, its impact on a favorable outcome is doubtful as immediate or delayed thromboembolic phenomenon in diagnostic cerebral angiography is an extremely rare observation that is mostly related to the technical aspects rather than contrast agent.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

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Factors Predicting Spontaneous Thrombosis of Aggressive Cranial Dural Arteriovenous Fistulas

et al. 2017

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Spontaneous Closure of Cerebral Dural Arteriovenous Fistulas with Direct Cortical Venous Drainage

Cited by 20 publications

References 14 publications

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

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

Spontaneous closure of a dural arteriovenous fistula

Factors Predicting Spontaneous Thrombosis of Aggressive Cranial Dural Arteriovenous Fistulas

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