Transvenous Embolization of Dural Arteriovenous Fistulas Through the Galenic (Deep Venous) System: Multicenter Case Series and Meta-Analysis

Visish M. Srinivasan, Katherine Karahalios, Marco Colasurdo, Emmajane Rhodenheiser, Lea Scherschinski, Tyler T. Lazaro, Gustavo Cortez, Bradley A. Gross, Anna Luisa Kühn, Ajit Puri, Ethan A. Winkler, Joshua S. Catapano, Yosuke Akamatsu, Ajith Thomas, Ricardo A. Hanel, Ajay Wakhloo, Ashutosh P. Jadhav, Andrew F. Ducruet, Felipe C. Albuquerque, Peter Kan

Research output: Contribution to journalArticlepeer-review


BACKGROUND AND OBJECTIVES: Arteriovenous fistulas involving the deep venous system have often been treated with microsurgery or transarterial embolization. Increasing familiarity with transvenous navigation and improved endovascular access systems may facilitate transvenous embolization (TVE) for these rare and challenging lesions. METHODS: We performed a retrospective study of neurointerventional databases of 6 high-volume centers. We identified all cases of arteriovenous fistulas with deep transvenous embolizations for arteriovenous fistula. Details regarding demographics, fistula characteristics, treatment considerations, clinical outcomes, and fistula occlusion were obtained and analyzed. The meta-analysis used the same inclusion criteria. RESULTS: Seventeen cases of TVE were identified. The most common reasons for TVE included prior treatment failure with microsurgery (n = 2) or transarterial embolization (n = 3) or inaccessible arterial pedicles (n = 4). For patients with full clinical outcome data (n = 14), 2 patients had worsened modified Rankin Scale, 8 patients had no change, and 4 were improved at a median clinical follow-up of 3.5 months. Angiographic obliteration was achieved in 15/17 cases (88.2%). In 1 case, catheterization around a sharp turn in the basal vein of Rosenthal could not be performed. In another case, despite successful TVE, there was residual lesion which was treated 1 year later by microsurgical clipping and excision. CONCLUSION: Transvenous approaches for embolization of deep arteriovenous fistulas have become possible with modern endovascular catheter systems and liquid embolics. These lesions can be treated safely and effectively through endovascular approaches, whichmay spare patients the traversal of deep structures needed formicrosurgical approaches to these regions. The outcomes of TVE are comparable with published outcomes of microsurgical interruption.

Original languageEnglish (US)
Pages (from-to)489-498
Number of pages10
JournalOperative Neurosurgery
Issue number6
StatePublished - Dec 25 2023
Externally publishedYes


  • Arteriovenous
  • Deep
  • Embolization
  • Fistula
  • Onyx
  • Shunts
  • Transvenous
  • Vein of Galen
  • Vein of rosenthal

ASJC Scopus subject areas

  • General Medicine


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