Digital imaging of background erasure and dural arteriovenous catheterization

This article was written by Specialist Doctor II Khong Tien Dat, Doctor of Radiology - Department of Diagnostic Imaging - Vinmec Ha Long International Hospital.

An intradural arteriovenous catheterization is when there is an anastomosis between the dural artery and vein. Patients have many manifestations, ranging from mild such as increased intracranial pressure to severe level such as cerebral hemorrhage. Regardless of the symptoms, interventional occlusion is the primary goal in treatment and digital imaging to remove the background for dural arteriovenous embolization is the preferred method of choice.

An intradural arteriovenous fistula is an abnormal connection between an artery and a dural vein. The location of this opening may be between arteries and veins in the brain, spinal cord, or other areas of the body. DRA tends to occur from middle age onwards and is usually not hereditary, meaning that children are not at risk of developing DVT even though their parents have the disease. this reason.
The cause of a DVT is thought to stem from whatever mechanism causes a narrowing or blockage of one of the venous sinuses of the brain, the pathway that carries blood from the intracranial cavity back to the heart. However, whatever the pathogenesis, some people with DVT may not have any symptoms while others present as an intracerebral hemorrhage. In particular, the signs of neurological defects occur very quickly, the patient suddenly has a headache, restlessness, struggling and perceptual disturbances. Some milder cases are convulsions, memory loss, impaired coordination of movements, paresthesias, lethargy, confusion... progressing slowly over a long time.
After diagnosis by the above clinical symptoms and especially based on cranial imaging tools such as computed tomography, repeat magnetic resonance imaging, cerebral angiography to show the progress of the disease, dural arteriovenous catheterization should be considered for early intervention. The techniques selected will depend on the characteristics of the stoma as well as the surgeon's advantages, including endovascular intervention, radiosurgery knife surgery, or classic craniotomy to interrupt the septal defect. intracranial dural vein.

Digital subtraction angiography and dural arteriovenous embolization have the aim of treating the closure of the stoma.
This is also a procedure similar to angiography but requires advanced technical expertise and more sophisticated control. The intervention will take place in the DSA room and the patient needs to be anesthetized. At this point, a catheter will be inserted into the major artery or vein in the thigh to approach as close to the opening as possible.
Here, through the catheter, different agents will be used to block the vessel such as metal coils, plastic beads, bio-glue and even stents. If an arteriovenous embolization is performed with a stent, the orifice is selectively closed while the venous sinus remains open.
With this type of treatment, the intervention is minimal and the patient only needs a few days in the hospital. In cases where the stoma is not embolized for various reasons, high-precision radiation surgery can be used instead to target and close the stoma. However, in some complex, selective cases, the stoma requires an open surgical procedure to directly close and the level of intervention will become more severe, with the risk of sequelae. .

The intervention to make the dural carotid artery embolization is a sophisticated technique, requiring high sophistication; Therefore, patients and relatives need to be thoroughly explained about the procedure to prepare to occur, as well as the associated risks, in order to request cooperation.
After receiving the approval, the patient needs to fast, change into appropriate clothes and arrange to lie on his back on the intervention table, place an intravenous line with 0.9% physiological saline solution. Means of monitoring breathing, pulse, blood pressure, electrocardiogram, SpO2 are mounted on the patient and the indicators are displayed on the screen for easy observation. The inguinal and genital areas will be cleaned, and the doctor will cover the area with a sterile towel in the area to be treated. In case the patient is overstimulated and poorly cooperated, it is necessary to consider appointing a sedative to facilitate the process.
Interventional embolization of dural arteriovenous fistula has a prominent difference compared with other endovascular embolization techniques in that it can access the location of the orifice by both arterial and venous routes. The choice of intervention route depends on the anatomical characteristics of the stoma, the availability of instruments such as skill, and the surgeon's familiarity.
For arterial occlusion, the doctor will insert a guide catheter measuring 6F into the femoral artery. Next is the microcatheter flow to the position where the hole is observed on the background eraser digital capture screen. Here, an amount of NBCA glue and Lipiodol either using Onyx or a metal helix is ​​pumped out to block the vessel. For venous catheterization, the physician inserts a 6F catheter into the femoral or jugular vein. Continue the flow of microcatheter through the sinus venous system to the position where the hole can be observed on the background screen. Here, an amount of bio-glue or metal spiral is pumped out to block the vessel.

Images of the entire cerebral circulation, arterial system and venous system will be re-examined on digital scan with background erasure. The anterior, middle, and posterior cerebral arteries on the contralateral and contralateral sides still circulate normally; At the same time, the dural arteriovenous shunt was completely occluded, and there was no longer dilation of the cavernous sinus, ophthalmic or dural veins. If these requirements are met, the intracranial interventions will be removed and the puncture site will be directly pressed by hand for about 15 minutes to stop bleeding, then bandaged for 8 hours. During this time, the patient needs absolute bed rest.

Because this is a sophisticated technique, any manipulation during the procedure carries the risk of tearing the arteries and veins of the brain, leading to cerebral hemorrhage or dissection of blood vessels. In addition, other complications are also related to the intervention such as stimulation of thrombosis, vasospasm response or displacement of embolization material...
After the end of the procedure, the location of the intervention if not If the bandage is good to stop bleeding, there will be a risk of hematoma or subcutaneous bleeding. However, this risk is similar to that of other arterial or venous endovascular interventions. If there are signs of infection after the procedure, antibiotics should be given to treat it.
In summary, thanks to advances in endovascular techniques, digital angiography and step-by-step dural arteriovenous embolization have proven to be the most appropriate treatment modality for this condition. With significant advantages such as minimally invasive, fast recovery time, this procedure is preferred. However, because there are always certain risks, it is necessary to choose a reliable medical center, a professional and experienced team is one of the decisive factors for success.
Vinmec Times City International General Hospital is not only famous for its professional quality in medical examination and treatment, but also stands out for its modern medical machinery system that is incorporated into the comprehensive health examination process. Therefore, when there are health problems and are indicated to take digital scans to erase the background and the dural arteriovenous catheter. Customers can contact Vinmec Times City International General Hospital to be examined by a doctor for appropriate indications.
For detailed advice, please come directly to Vinmec health system or register online HERE.