Non-galenic arteriovenous fistulas in adults: transarterial embolization and literature review.

Lin, Ning; Brouillard, Adam M; Snyder, Kenneth V; Levy, Elad I; Siddiqui, Adnan H

BACKGROUND Non-galenic dural arteriovenous fistula (NGAVF) is a rare congenital vascular abnormality characterized by high flow connections between cerebral arteries and a dilated pial venous varix. These lesions have been reported mostly in the pediatric population. OBJECTIVES To examine the clinical features and treatment outcomes for adult (≥ 18 years) patients with NGAVFs. METHODS We retrospectively reviewed the records of patients with NGAVFs who underwent endovascular treatment between 2008 and 2013. A PubMed literature search was conducted to identify reports of adult patients with these lesions. RESULTS Two adults with NGAVFs were treated at our institution via transarterial embolization with a favorable outcome. The literature search revealed 24 adult NGAVF cases. Among these cases and ours, mean patient age was 33.4 ± 13.3 years, and 13 were women. Most patients experienced protracted neurological symptoms at the time of treatment whereas 5 (19.2%) patients presented with acute hemorrhage. 18 patients had single hole fistulas; 8 had multi-hole fistulas. 11 patients were treated by microsurgical ligation, 10 by embolization, 4 by combined therapy, and 1 with observation. Two patients died of reperfusion hemorrhage. Women were more likely to have a favorable outcome than men (100% vs 75.0%; p=0.07). No statistical difference was found in terms of clinical outcome for patients with single hole versus multi-hole fistulas or those treated by surgery versus embolization. CONCLUSIONS NGAVFs are extremely rare in the adult population and present a similar clinical course as in older children. In our experience, transarterial embolization can be safely and effectively utilized for the treatment of these lesions in adults.