Spinal arteriovenous fistulas in adults: Management of a series of patients treated at a neurology department

Neurologia (Engl Ed). 2018 Sep;33(7):438-448. doi: 10.1016/j.nrl.2016.12.001. Epub 2017 Feb 16.
[Article in English, Spanish]

Abstract

Objective: Spinal arteriovenous fístulas (SAVF), a rare type of vascular malformation, account for 3% of all spinal cord lesions. Without early treatment, the associated morbidity is high; furthermore, SAVF pose a major diagnostic challenge. Our purpose was to evaluate the clinical characteristics of SAVF and review their progress after treatment to determine whether it may be too late for treatment in some cases.

Methods: We present a retrospective series of 10 patients diagnosed with SAVF and treated at a tertiary hospital during a 3-year period.

Results: In our sample, SAVF were found to be significantly more frequent in men (80%). Mean age in our sample was 65.4 years. The most common initial symptom was intermittent claudication/paraparesis (70%). In most patients, symptoms appeared slowly and progressively. At the time of diagnosis, the most common symptoms were motor, sensory, and sphincter disorders. Mean time from symptom onset to diagnosis was 24.3 months. Initial diagnosis was erroneous in 60% of the patients. Spinal MRI was diagnostic in 90% of these cases and arteriography in 100%. The most common location of the fistula was the lower thoracic region and the most frequent type was dural (7 cases). All patients were treated with embolisation, surgery, or both and 70% improved after fistula closure regardless of progression time.

Conclusions: Diagnosis of SAVF is difficult and often delayed, which leads to poorer patient prognosis. We should have a high level of suspicion for SAVF in patients with intermittent claudication or paraparesis exacerbated by exercise. Early treatment should be started in these patients. Treatment should always aim to improve quality of life or stabilise symptoms, regardless of progression time.

Keywords: Arteriografía espinal; Enfermedad vascular espinal; Fístula arteriovenosa dural espinal; Fístula arteriovenosa espinal; Malformación vascular espinal; Mielopatía; Myelopathy; Spinal angiography; Spinal arteriovenous fistula; Spinal dural arteriovenous fistula; Spinal vascular disorder; Spinal vascular malformation.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arteriovenous Fistula / diagnosis*
  • Arteriovenous Fistula / diagnostic imaging
  • Arteriovenous Fistula / surgery
  • Arteriovenous Fistula / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Spinal Cord Diseases / diagnosis*
  • Spinal Cord Diseases / diagnostic imaging
  • Spinal Cord Diseases / surgery
  • Spinal Cord Diseases / therapy*