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Spontaneous resolution of low-flow spinal arteriovenous fistulas

  • Spinal Neuroradiology
  • Published:
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Abstract

Purpose

Spinal vascular anomalies with arteriovenous blood shunting include spinal arteriovenous malformations (SAVMs) and spinal arteriovenous fistulas (SAVFs), which are distinguished by the presence or absence of an interposed nidus. SAVFs can be further characterized based on their location (perimedullary, dural, or extradural) and flow pattern (high-flow versus low-flow shunts). The spontaneous resolution of a spinal vascular malformation, i.e., the complete disappearance—in the absence of therapeutic measures—of a lesion previously identified by angiography, seems to represent an exceptional phenomenon.

Methods

This study retrospectively analyzed seven patients with spontaneously resolving spinal vascular malformations observed by the senior author between January 2008 and April 2017.

Results

A total of 143 spinal vascular malformations were angiographically evaluated during the considered time period, including nine spontaneously resolving SAVFs in six patients, seven spinal epidural fistulas, and two spinal dural arteriovenous fistula.

Conclusion

The “spontaneous” resolution of spinal vascular malformations appears to selectively involve SAVFs. While vessel wall alterations previously documented on the venous side of SAVFs may play an important role in the regression of these lesions, angiography seems to represent a significant contributing factor, probably through the prothrombotic properties of nonionic contrast agents.

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Authors and Affiliations

  1. Division of Interventional Neuroradiology, The Johns Hopkins Hospital, 1800 E Orleans Street, Bloomberg 7216, Baltimore, MD, 21287, USA

    Joe Kang, Lydia Gregg & Philippe Gailloud

Authors
  1. Joe Kang
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  2. Lydia Gregg
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  3. Philippe Gailloud
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Corresponding author

Correspondence to Philippe Gailloud.

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Funding

No funding was received for this study.

Conflict of interest

PG consults for Codman Neurovascular and has received research grants from Siemens Medical.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Cite this article

Kang, J., Gregg, L. & Gailloud, P. Spontaneous resolution of low-flow spinal arteriovenous fistulas. Neuroradiology 59, 1003–1012 (2017). https://doi.org/10.1007/s00234-017-1888-x

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  • DOI: https://doi.org/10.1007/s00234-017-1888-x

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