Distortion and retraction injury at the hair-pin portion of the radiculomedullary artery during endovascular therapy for arteriovenous fistulas of the filum terminale

Abstract

Background: Filum terminale arteriovenous fistulas (FTAVFs) are rare spinal arteriovenous shunt. Transarterial embolization via the radiculomedullary artery (RMA)–anterior spinal artery (ASA) axis is generally accepted as a standard technique. However, embolization via the RMA–ASA axis, which involves long distances and tortuous running, is technically challenging. Case description: We report a 25-year-old man with multiple FTAVFs supplied from the Th9 RMA–ASA axis. Retraction injury and distortion of the hair-pin portion of the RMA occurred due to microcatheter withdrawal after n-butyl-2-cyanoacrylate injection from the RMA–ASA axis. We attempted to repair the RMA distortion by microcatheter manipulation without worsening the neurological condition. Conclusions: Transarterial embolization via the RMA–ASA axis is associated with risk of vessel injury during catheter withdrawal through the involved long distance and its tortuous course.

Keywords

• Anterior spinal artery
• Distortion
• Endovascular
• Filum terminale
• Injury
• Radiculomedullary artery