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Endovascular Treatment of a Spinal Dural Arteriovenous Fistula Arising From the Internal Iliac Artery 2011

Interventional Spine

Clayton, L, Vandergriff, MD
Michael, J, Opatowsky, MD, Non ASSR Member
Kyle, Doughty, MD, Non ASSR Member
Kennith, F, Layton, MD, Non ASSR Member

Poster

Purpose

Though accounting for only three percent of spinal masses, the spinal dural arteriovenous fistula (DAVF) is the most common vascular malformation of the spine. Its nonspecific symptoms mimic more common conditions leading to delayed diagnosis. Presented is a patient with a spinal dural arteriovenous fistula arising from an unusual arterial source, the internal iliac artery. The fistula was diagnosed with spinal angiography and successfully treated with endovascular embolization at Baylor University Medical Center, Dallas, Texas.

Methods & Materials

An 82 year old man presented to his family practitioner with complaints of lower extremity numbess and weakness for three years. The development of bladder and bowel dysfunction prompted a visit to his local neurosurgeon. An MRI of the thoracic and lumbar spine was performed. Sagittal T2 weighted images showed multiple tubular, hypointense flow voids in the dorsal subarachnoid space, suggesting dilated vessels. The spinal cord at the level of the conus medullaris was noted to be enlarged, with abnormal T2 signal elevation(Figure 1). The initial catheter spinal angiography performed at an outside institution proved all intercostal and lumbar arteries to be normal, but the internal iliac arteries were not evaluated. The patient was referred to Baylor University Medical Center for a second spinal angiogram.

Results

The patient underwent a second spinal angiography in which an abnormal vascular shunt was noted to arise from an unusual source, a posterior divisional branch of the left internal iliac artery, at the level of the second sacral foramen (Figure 2). A large arterialized vein coursed cephalad, corresponding to the abnormal vessel seen on the MRI exam. Through a microcatheter, Onyx embolic material was infused with obliteration of the venous pouch and proximal portions of the draining vein (Figure 3). There were no immediate or delayed complications. At three month follow-up, the patientâ