From the Guidelines
If liquid embolic material enters the spinal perimedullary veins through the radicular vein during treatment of a spinal dural arteriovenous fistula, it can cause severe and potentially permanent neurological damage, emphasizing the need for precise and controlled embolization techniques to prevent such complications. This complication occurs when the embolic agent travels beyond the intended target of the fistulous connection and into the normal venous drainage of the spinal cord, resulting in venous occlusion and infarction of the spinal cord tissue, which can lead to immediate neurological deterioration including paralysis, sensory deficits, and loss of bowel and bladder function 1. The severity depends on the location and extent of the venous occlusion, with thoracolumbar regions often resulting in paraplegia and cervical regions potentially causing quadriplegia. Key considerations in preventing this complication include:
- Careful angiographic assessment to identify the precise location of the fistula and its venous drainage
- Superselective catheterization to deliver the embolic material directly to the fistula while minimizing the risk of reflux into the normal venous circulation
- Controlled injection of embolic material under continuous fluoroscopic monitoring to ensure that the material does not extend beyond the intended target. Given the potential for severe neurological damage, prevention through meticulous technique and immediate recognition of complications is crucial, as treatment options are limited once the embolic material has solidified, though high-dose corticosteroids may be administered to reduce inflammation.
From the Research
Spinal Dural Arteriovenous Fistula (AVF) Treatment
If liquid embolic material enters the spinal perimedullary veins through the radicular vein during spinal dural arteriovenous fistula (AVF) treatment, several complications can occur.
- The embolic material can cause an occlusion of the perimedullary veins, leading to venous congestion and potentially resulting in spinal cord injury or infarction 2, 3.
- The liquid embolic agent can also penetrate the fistula's nidus and achieve venous penetration, which is a desired outcome in some cases, but it requires careful control to avoid excessive penetration and potential complications 4.
- In some instances, the embolic material may not penetrate the fistula's nidus adequately, leading to suboptimal treatment results 4.
- Additionally, the use of liquid embolic agents can be associated with technical complications, such as catheter occlusion or agent migration, which can impact the success of the treatment 5, 6.
Potential Consequences
The potential consequences of liquid embolic material entering the spinal perimedullary veins through the radicular vein during AVF treatment include: