Embolization of Spinal Dural Arteriovenous Fistulae Using a Nonadhesive Liquid Embolic Agent Delivered Via a Dual-Lumen Balloon Catheter

Abstract

A spinal dural arteriovenous fistula is the most common type of spinal vascular malformation. The principal aim of endovascular treatment is to occlude the fistula site and the proximal part of the draining vein. However, this is not always possible because selective catheterization can be difficult in patients with tortuous feeding arteries, and there is a risk of liquid embolic agent reflux. Herein, we present a novel technique. We use a dual-lumen balloon catheter to inject a liquid embolic agent into the fistula. The pre-inflated balloon prevents proximal reflux and also engages in forward pushing that augments distal penetration of the embolic agent. An absolute prerequisite is a lack of radiculomedullary branches arising from the same segmental feeding artery; careful angiographic examination is mandatory. Use of the dual-lumen balloon catheter technique when long tortuous feeding arteries supply the spinal dural arteriovenous fistula ensures safe and successful embolization with a low risk for complications. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.