Ces radiol. 2019, 73(3):191-197 | DOI: 10.55095/CesRadiol2019/028

Role of the spinal selective angiography in diagnosis of spinal dural arteriovenous fistulasOriginal article

Antonín Krajina¹, Miroslav Lojík¹, Dagmar Krajíčková², Jaroslav Storm¹, Pavel Ryška¹, Vendelín Chovanec¹, Radka Dvořáková¹, Jan Raupach¹, Michal Rek¹, Jaroslav Adamkov³, Tomáš Česák³

¹ Radiologická klinika LF a FN, Hradec Králové

² Neurologická klinika LF a FN, Hradec Králové

³ Neurochirurgická klinika LF a FN, Hradec Králové

Purpose: Spinal selective angiography (SSA) is due to its extension one of the most demanding angiographic studies with high radiation dose. The retrospective study analysed single centre experience with the most frequent indication which was the dural arteriovenous fistula (dAVF) location during last 5 years.

Methods: There were 50 SSAs performed in our department between 2014 and 2019. The study included 31 patients with suspection on the dAVF of average age 65.7 years (ranged from 25 to 90 years). All patients had at least one MR imaging of the spine for peripheral paresis, and/or urinary problems. Indication for the SSA was done by a neurologist, neurosurgeon or interventional neuroradiologist. The SSA were performed from femoral approach in local anesthesia using biplane angiographic machine. Selective injections of the intercostal and lumbal arteries were registered during procedure, to prevent repeating or skipping of some levels. Numbers of angiographic runs, positive finding of dAVF, location of radiculomedullary and radiculopial arteries, and radiaton doses were recorded in each examination.

Results: There were 31 patients indicated for suspection of the dAVF out of 50 patients indicated for the SSA. The dAVF was confirmed in 26 (83%) patients. The SSA had 22.3 angiographic runs (ranged 6-37 runs). The dAVF feeders were equally distributed on the right and left side with two maximum peaks. The cranial peak was at the level of T6 a T7, caudal one was at L1. The thoracolumbal dAVFs occurred in patients above the age of 48 years and more often in men than in women (69% versus 31%). The radiculomedullary arteries arised more often on the left side than on the right (69% versus 31%).

Discussion: The study revealed that keeping strict angiographic protocol, the dAVF feeders can be proved in 83% patients suspected for thoracolumbal dAVF and origin of the radiculomedullary arteries is localised too. Age, gender, craniocaudal location of the dAVF, and extension of the SSA were studied as well.

Keywords: angiography, spinal dural arteriovenous fistula, anterior spinal artery

Accepted: September 15, 2019; Published: September 1, 2019  Show citation