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Abstract
Background Arteriovenous shunts below conus medullaris (AVS-BC) are understudied, particularly those associated with spinal dysraphism. This study aimed to refine the classification and management of AVS-BC.
Methods A retrospective analysis of patients with AVS-BC from two centers over two decades was performed, focusing on clinical presentations, angioarchitecture, and treatment outcomes. AVS-BC was classified into eight subtypes based on angioarchitecture, dural relation, and spinal dysraphism presence. Treatment efficacy was evaluated using changes in the modified Aminoff and Logue’s Scale and the modified Denis Pain and Numbness Scale.
Results The cohort included 140 patients (85.0% male) with a median onset age of 54 years (IQR 47–62). Spinal dural arteriovenous fistula was the most prevalent subtype (32.1%). AVS-lipoma (58.8%) and AVS with spina bifida/meningocele (75.0%) were mainly located in S3–S5, while others were above S2 (p<0.001). Most AVS-BCs were supplied by the internal iliac artery (37.1%) and drained intradurally (96.4%). Venous lakes were common in spinal epidural arteriovenous fistula (88.2%) and paravertebral arteriovenous fistula (100.0%). Larger drainage veins (>2.0 mm) were found in paravertebral arteriovenous fistula (PVAVF) (50.0%) and AVS with spina bifida/meningocele (AVS-SBD) (50.0%) (p=0.012). Embolization was the preferred treatment (50.7%), achieving a 97.1% anatomical cure rate. Despite functional improvements, 25% experienced deterioration during a median follow-up of 47 months (IQR 20–113).
Conclusions The refined AVS-BC classification revealed significant angioarchitectural variations. Tailored treatment strategies, especially embolization, resulted in high anatomical cure rates, though post-treatment deterioration warrants further investigation.
- Angiography
- Vascular Malformation
- Lumbosacral
- Fistula
Data availability statement
Data are available upon reasonable request. The data that supported the findings of this study are available from the corresponding author upon reasonable request.
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Data availability statement
Data are available upon reasonable request. The data that supported the findings of this study are available from the corresponding author upon reasonable request.
Footnotes
Y-xF and C-bY contributed equally.
Contributors HZ and YF conceptualized the study; YF drafted the initial manuscript; YF, CY, JL, JW, PH, MY, GL, LB, YM, and PZ conducted data collection and analysis. YF, CY, JL, and JW prepared figures, PH, PZ, YM, and HZ undertook comprehensive revisions and editing. HZ and YM acquired funding. All authors have reviewed and endorsed the manuscript. HZ is the guarantor.
Funding This study was funded by the National Natural Science Foundation of China (No 82101460 and 82220108010).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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