Left Distal Transradial Approach for the Treatment of a Sacral Extradural Arteriovenous Fistula: A Technical Note and Literature Review
Left Distal Transradial Approach for the Treatment of a Sacral Extradural Arteriovenous Fistula: A Technical Note and Literature Review
复制标题
左远端经桡动脉入路治疗骶骨硬膜外动静脉瘘：技术说明和文献综述
DOI：
10.1016/j.wneu.2023.02.141
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发表时间：
2023
影响因子：
2
通讯作者：
Murata Hidetoshi
中科院分区：
文献类型：
--
作者：
Ito Hidemichi;Uchida Masashi;Kaji Tomohiro;Fukano Takayuki;Hagiwara Yuta;Takasuna Hiroshi;Murata Hidetoshi
背景：骶骨硬膜外动静脉瘘（SEAVF）相对罕见，其病因尚不清楚。它们主要由骶外侧动脉（LSA）供血。在血管内治疗中，引导导管的稳定性和微导管对LSA远端的瘘的可达性都是对瘘点进行充分栓塞的必要条件。这些血管的插管需要在主动脉分叉处交叉或经股动脉入路逆行插管。然而，动脉粥样硬化的股动脉和弯曲的髂主动脉会使手术在技术上变得困难。尽管右经桡骨入路（TRA）可以通过矫正入路来减少这种困难，但由于它经过主动脉弓，因此仍有发生脑栓塞的潜在风险。在这里，我们提出了一个使用左远端TRA成功栓塞SEAVF的病例。方法我们报告一例47岁男性SEAVF患者采用左远端TRA栓塞治疗。腰椎血管造影显示SEAVF有一条硬膜内静脉通过硬膜外静脉丛，由左左肋下动脉供给。使用左侧远端TRA经降主动脉将6-French引导鞘置入髂内动脉。微导管可以从放置在LSA的中间导管进入瘘点上方的硬膜外静脉丛。用线圈和氰基丙烯酸酯正丁酯栓塞成功。结果SEAVF在神经影像学上完全消失，患者逐渐康复。结论左远端TRA是一种有效、安全、微创的SEAVF栓塞方法，尤其适用于有主动脉源性栓塞或穿刺部位并发症高危因素的患者。
BackgroundSacral extradural arteriovenous fistula (SEAVF) is relatively rare, and its etiology is unknown. They are mostly fed by the lateral sacral artery (LSA). For endovascular treatment, both the stability of the guiding catheter and accessibility of the microcatheter to the fistula, distal to the LSA are required for sufficient embolization of the fistulous point. Cannulation of these vessels requires either crossover at the aortic bifurcation or retrograde cannulation using the transfemoral approach. However, atherosclerotic femoral and tortuous aortoiliac vessels can make the procedure technically difficult. Although the right transradial approach (TRA) can reduce this difficulty by straightening the access route, a potential risk remains for cerebral embolism because it passes the aortic arch. Herein, we present a case of successful embolization of a SEAVF using a left distal TRA.MethodsWe report a case of a 47-year-old man with SEAVF treated with embolization using a left distal TRA. Lumbar spinal angiography showed a SEAVF with an intradural vein through the epidural venous plexus fed by the left LSA. A 6-French guiding sheath was cannulated into the internal iliac artery via the descending aorta using the left distal TRA. A microcatheter could be advanced into the extradural venous plexus over the fistula point from the intermediate catheter placed at the LSA. Embolization with coils and n-butyl cyanoacrylate was successfully performed.ResultsThe SEAVF completely disappeared on neuroimaging, and the patient gradually recovered.ConclusionsLeft distal TRA could be a useful, safe, and less invasive option for the embolization of SEAVF, especially for patients with high-risk factors for aortogenic embolism or puncture site complications.