Forearm-only transarterial and transvenous approach for endovascular intervention of dural arteriovenous fistula.

Abstract

BackgroundTransradial arterial access has become widely used as a less invasive approach in neuroendovascular therapy, but the forearm venous approach has rarely been reported.ObjectivesThis study aimed to assess the safety and efficacy of forearm transvenous neurointervention for intracranial lesions. We present our experience with a simultaneous forearm-only transarterial and venous approach (fTAVA) for dural arteriovenous fistulas (dAVFs).MethodsWe retrospectively reviewed a prospective database of consecutive patients who underwent fTAVA for dAVFs between 2021 and 2024. fTAVA was performed using the right radial artery and superficial forearm vein as puncture sites. Arterial closure was achieved using a radial compression device, whereas bandage compression was used for venous closure. Procedural success, angiographic results, procedure-related complications and patient satisfaction were evaluated.ResultsOverall, 13 (8 carotid-cavernous sinus and 5 transverse-sigmoid sinus fistulas) procedures using fTAVA were successfully performed with favorable outcomes. Arterial puncture was performed at the distal radial artery in nine cases. The venous puncture site was the median cubital vein in nine cases and the forearm cephalic vein in four cases. The targeted fistulas were distal to the right jugular vein in four cases and the left jugular vein in nine cases. They were successfully accessed in all cases. The angiographic result was total occlusion in eleven cases and subtotal occlusion in two cases. There was one patient with minor access-site complication in distal radial artery.ConclusionsThe fTAVA is a safe and effective method for the endovascular treatment of dAVFs and is associated with reduced patient discomfort.