Staged embolisation strategy for spinal epidural arteriovenous fistula with concomitant pulmonary arteriovenous malformation.
Shun Tanaka, Hisayuki Hosoo, Takeshi Yoshimoto et al.
✦ AI-curated · Sources linked
Case in brief
An elderly woman presented with progressive paraparesis due to a suspected spinal arteriovenous shunt. During her hospitalization, she experienced multiterritory embolic stroke, leading to the discovery of bilateral deep venous thrombosis and a large pulmonary arteriovenous malformation (PAVM). Spinal angiography confirmed a spinal epidural arteriovenous fistula (SEDAVF). A staged embolization strategy was employed, successfully treating both the PAVM and SEDAVF without complications.
What made this case unusual
The case is notable for the staged embolization strategy necessitated by the presence of a high-grade extracardiac right-to-left shunt from the PAVM, which posed a risk of embolic migration during treatment.
Diagnostic / clinical pearl
Clinicians should consider the vascular anatomy and hemodynamics when planning treatment for patients with coexisting arteriovenous shunt lesions to avoid complications.
Why it matters
This case underscores the need for tailored treatment strategies in complex vascular conditions, particularly when multiple arteriovenous lesions are present.