Transvenous Embolisation of Dural Arteriovenous Fistulas with Combination of Guglielmi Detachable Coils and Onyx: Preliminary Experience and Evaluation of the Clinical Outcomes

Full Article

VWT Chan, SSM Lo, DPH Wong, KF Fok, KW Tang

Hong Kong J Radiol 2019;22:56-63

Introduction: The current mainstay treatment strategy for dural arteriovenous fistulas (DAVFs) is endovascular therapy. The use of transarterial Onyx 18 for treatment of DAVFs has been established, but there is limited literature on transvenous embolisation of DAVFs using Onyx 18 and Guglielmi detachable coils (GDCs). We herein present our preliminary experience of combined use of Onyx 18 and GDCs in treatment of DAVFs using a transvenous approach. Endovascular techniques, clinical and angiographic outcomes, and complications are discussed. We aimed to share our experiences to provide a foundation for future studies to improve patient care.
Methods: We retrospectively analysed all patients with DAVF (n=5, age 23-60 years) with endovascular treatment using Onyx 18 and GDCs performed in the same session, who were treated in our institution between 2014 and 2015. The double-catheter technique with transvenous approach was performed in all five cases. Treatment response and complications were evaluated clinically. We assessed the treatment outcomes with digital subtraction angiogram at 6 months and 18 months after embolisation, assessing the degree of residual arteriovenous shunting and presence of cortical venous reflux.
Results: Among the five reviewed cases, all achieved symptom alleviation. In two (40%) cases of DAVFs complete obliteration was achieved in the first session of embolisation; in one case significant reduction of arteriovenous shunting was achieved. In two (40%) cases, significant reduction of flow into DAVF was achieved after two separate sessions of embolisation. There were no reported cases of new neurological deficits after the procedures.
Conclusion: Onyx 18 in combination with GDCs using transvenous approach for DAVF treatment is a safe and feasible method, with a reasonably high success rate in a small sample. As DAVF is a spectrum of diseases with different severities and locations, treatment approaches should be highly individualised and a multidisciplinary approach should be adopted.


Author affiliation(s):
VWT Chan, SSM Lo, DPH Wong, KF Fok, KW Tang: Department of Radiology and Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong







引言: 目前硬腦膜動靜脈瘺(DAVFs )的主要治療策略是血管內治療。雖然目前可使用經動脈Onyx18 液體栓塞劑治療DAVF ,但有關結合Onyx 18 和Guglielmi 分離式線圈(GDC )進行DAVF 的經靜脈栓塞的文獻有限。本文分享我們結合Onyx 18 和GDCs 進行經靜脈DAVF 的初步經驗,並討論血管內技術、臨床和血管造影結果以及併發症。作者希望透過分享經驗,促使未來研究能改善患者診療。
方法: 回顧分析5 名DAVF 患者(年齡介乎23-60 歲)於2014 年至2015 年期間在我們醫院以Onyx 18 和GDCs 進行一次性血管內治療。在所有病例中都使用經靜脈入路雙導管技術。臨床評估包括治療效果和併發症。在栓塞後6 個月和18 個月用數字減影血管造影評估治療結果,並評估殘餘動靜脈分流的程度和是否存在皮質靜脈回流。
結果: 在回顧的五宗病例中,所有症狀均有緩解。兩宗(40% )DAVF 病例在首次栓塞中完成了閉合,當中一例的靜脈分流顯著減少。兩宗(40% )病例經過兩次獨立的栓塞治療後,靜脈分流顯著減少。沒有出現神經功能缺損的病例。
結論: Onyx 18結合 GDCs進行經靜脈DAVF治療安全可行,在小樣本量的研究中具有相當高的成功率。由於DAVF是一種涉及不同嚴重程度和位置的疾病,因此治療方法應高度個性化,採用多學科方法對每位患者進行個體化治療。