A Patient with Spinal Epidural Arteriovenous Fistula Cured by Balloon-assisted Transarterial Embolization under Flow Control

Abstract

Objective: In transarterial embolization (TAE) of spinal epidural arteriovenous fistula (SEDAVF), it is essential to control the blood flow at the shunt point. We report a case of SEDAVF treated with TAE with occluding one of several segmental arteries (SAs) involved in the shunt using a balloon. Case Presentation: A 68-year-old male presented with gait disturbance and bladder bowel dysfunction. Lumbar spinal MRI showed a dilated and tortuous vein around the spinal conus. Spinal angiography revealed a SEDAVF with intradural venous reflux through the epidural venous plexus fed by the branches of the right 2nd and 3rd lumbar arteries (L2 and L3). We infused 14% n-buthyl-2-cyanoacrylate (NBCA) from the feeder of the L2 under the flow control by occluding L3 using a balloon and achieved complete obliteration of the arteriovenous shunt. Conclusion: In treatment of SEDAVF with feeders from several SAs, TAE with occluding one of the SAs using a balloon is a useful method.