Avtor/Urednik     Šeruga, Tomaž
Naslov     Endovaskularno zdravljenje spontane duralne arteriovenske fistule
Prevedeni naslov     Endovascular treatment of spontaneous dural arteriovenous fistula
Tip     članek
Vir     Zdrav Vestn
Vol. in št.     Letnik 68, št. 1
Leto izdaje     1999
Obseg     str. 5-8
Jezik     slo
Abstrakt     Background. Endovascular treatment of spontaneous dural arteriovenous fistula (DAVF) with microparticles. Methods. A 42-year old man motical spontaneous left sided bruit six month before treatment. External carotid angiography showed a direct DAVF. Superselective angiography of left occipital artery specified fistula between small meningeal branch of left occipital artery and left sinus transversus. Fistula was drained by ipsilateral transverse sinus, that means Grade I DAVF. A Tracker 18 microcatether was placed into distal part of the occipital artery and embolisation was performed with microparticles. Results. After the embolisation of meningeal branch of the occipital artery, bruit dimished and disapeared already during the procedure. After the closure of this part of fistula, we noticed two smaller feeders arising from midle meningeal artery also supplying the fistula. They were not present before the oclusion of the mean feeder. Also thse two small arteries were embolised. Control angiography, at the en dof treatment, did not show any abnormalities and there was no fistula. Conclusions. Endovascular treatment of Grade I DAVF is atherapy of choice for this kind of fistula. Only in a minimal percent of Grade I fistulas treatment by transfemoral aproach and superselective embolisation is unsuccessful. Direct microsurgical therapy of simptomatous DAVF is also effective, but is of higher risk especialy in case of massive bleeding.
Izvleček     Izhodišča. Prikaz endovaskularnega zdravljenja spontane duralne arteriovenske fistule (DAVF) z uporabo mikropartiklov. Metode. pri 42-letnem pacientu se je šest mesecev pred posegom spontano pojavilo šumenje v levem ušesu. Angografija leve zunanje karotidne arterije je pokazala DAVF med meningealno vejo okcipitalne arterije in levim transverzalnim sinusom. Drenaža DAVF je potekala po istostranskem venskem sinusu v anterogradni smeri, kar jo je po delitvi uvrščalo v prvo skupino. Z uporabo Tracker-18 mikrokatetra smo superselektivno kateterizirali distalni del leve okcipitalne arterije in embolizirali fistulo z mikropartikli. Rezultati. Po embolizaciji meningealne veje okcipitalne arterije je pacientu šumenje v ušesu prenehalo ze med samim posegom. Po zaprtju tega dela fistule smo opazili še dve manjši veji srednje meningealne arterije, ki sta prav tako polnili fistulo, vendar se pred zaprtjem glavne polnilne arterije nista angiografsko manifestirali. Poseg smo razširili in opravili še embolizacijo obeh drobnih arterij. Ob koncu posega smo opravili še kontrolno angiografijo, ki ni več pokazala znakov polnitve fistule. Zajkhyčki. Endovaskularno zdravljenje DAVF tipa I je najprimernejša terapija, saj le minimalnega odstotka fistul te stopnje ni mogoče zapreti s superselektivno embolizacijo s transfemoralnim pristopom. Neposredna mikrokiruška terapija simptomatskih fistul je prav tako učinkovita, je pa vsekakor bolj zahtevna, posebej če pride do močnejših krvavitev.
Deskriptorji     ARTERIOVENOUS FISTULA
DURA MATER
EMBOLIZATION, THERAPEUTIC
CRANIAL SINUSES
ADULT
CAROTID ARTERY DISEASES
OCCIPITAL LOBE
MENINGEAL ARTERIES