Usefulness of three-dimensional digital subtraction angiography and technique of 'kick turn method' for endovascular treatment of spinal dural AVF: A case report

Abstract

Three-dimensional digital subtraction angiography (3D-DSA) provides better comprehension of vascular lesion architecture. We report the usefulness of 3D-DSA for endovascular treatment of spinal dural arteriovenous fistula and present the catheterization technique called 'kick turn method'. Case : A 60-year-old male patient with a one-year history of bilateral leg hypesthesia presented with gait disturbance and urinary hesitation three months before treatment. Spinal angiography revealed a dural arteriovenous fistula fed by radicular artery branching from the left T10 intercostal artery and a draining vein proceeding superiorly along the perimedullary veins. Endovascular embolization was performed. Selective T10 3D-DSA clearly demonstrated a feeding artery, fistula point and draining vein. 3D-DSA rotational imaging demonstrated the tortuous course of the feeder and the relationship among the feeding artery, fistula and draining veins. This information was useful for manipulating the microcatheter and NBCA injection. Since the radicular artery branched off at a sharp angle from the intercostal artery, the ventral branch was embolized by coils and the microcatheter was made to turn with that coil mass and guided into the target feeder (kick turn method). Successful obliteration of the fistula was achieved. Conclusion : Selective spinal 3D-DSA helps the interventionalist to better understand the complex spinal vascular architecture and to select good working angles. The usefulness results in good operative and clinical outcomes. The 'kick turn method' is useful for manipulating the microcatheter into the sharply-angled vessel branch.