Endovascular treatment for scalp arteriovenous fistulas: prospects and dilemmas

IF 2 4区 医学 Q3 CLINICAL NEUROLOGY Acta neurologica Belgica Pub Date : 2023-10-25 DOI:10.1007/s13760-023-02401-z
Jinlu Yu
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Abstract

Scalp arteriovenous fistula (AVF) is an anomalous arteriovenous connection without a capillary bed. For symptomatic scalp AVFs, an appropriate treatment must be chosen. Currently, endovascular treatment (EVT) can serve as an alternative to surgical excision. However, EVT of scalp AVFs constitutes a challenge. A standard EVT strategy for scalp AVFs has not yet been established. Therefore, a review of current research on EVT for scalp AVFs is essential. In this review, the following issues were discussed: scalp vessel anatomy; etiology, angioarchitecture and classification of scalp AVFs; EVT principles and techniques; and EVT complications and prognosis. In addition, we attempted to propose a feasible grading system with 4 grades. Based on the literature review and our experience, we found that scalp AVFs have a complex angioarchitecture, which made EVT only possible in specific cases with low-grade scalp AVFs. EVT can be performed by transarterial or transvenous embolization. Direct puncture embolization can also be used for scalp AVFs. Complete occlusion of scalp AVF by EVT had low complication and recurrence rates and a good prognosis.

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头皮动静脉瘘的血管内治疗:前景与困境。
头皮动静脉瘘(AVF)是一种没有毛细血管床的异常动静脉连接。对于有症状的头皮动静脉畸形,必须选择适当的治疗方法。目前,血管内治疗(EVT)可以作为手术切除的替代方案。然而,头皮动静脉畸形的EVT是一个挑战。头皮AVF的标准EVT策略尚未建立。因此,对EVT治疗头皮动静脉畸形的研究现状进行综述是必要的。在这篇综述中,讨论了以下问题:头皮血管解剖;头皮动静脉畸形的病因、血管结构和分类;EVT原理和技术;EVT并发症及预后。此外,我们试图提出一个可行的4个等级的评分系统。根据文献综述和我们的经验,我们发现头皮动静脉畸形具有复杂的血管结构,这使得EVT仅在头皮低级别动静脉畸形的特定病例中可行。EVT可以通过经动脉或经静脉栓塞进行。直接穿刺栓塞也可用于头皮动静脉畸形。EVT完全闭塞头皮AVF并发症少,复发率低,预后良好。
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来源期刊
Acta neurologica Belgica
Acta neurologica Belgica 医学-临床神经学
CiteScore
4.20
自引率
3.70%
发文量
300
审稿时长
6-12 weeks
期刊介绍: Peer-reviewed and published quarterly, Acta Neurologica Belgicapresents original articles in the clinical and basic neurosciences, and also reports the proceedings and the abstracts of the scientific meetings of the different partner societies. The contents include commentaries, editorials, review articles, case reports, neuro-images of interest, book reviews and letters to the editor. Acta Neurologica Belgica is the official journal of the following national societies: Belgian Neurological Society Belgian Society for Neuroscience Belgian Society of Clinical Neurophysiology Belgian Pediatric Neurology Society Belgian Study Group of Multiple Sclerosis Belgian Stroke Council Belgian Headache Society Belgian Study Group of Neuropathology
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