Endovascular embolization of dural arteriovenous fistulas: an 8-year single-centre experience and comparison with contemporary literature

Purpose: Dural arteriovenous fistulas (DAVFs) are complex vascular malformations characterised by abnormal com-munications between the meningeal arteries and dural venous sinuses or cortical veins. They may be associated with underlying thrombotic associations such as the presence of cerebral venous sinus thrombosis (CVST) or transverse-sigmoid sinus (TSS) occlusion, which can affect prognostic outcomes. Additionally, the types of DAVFs may also have varying clinical and technical outcomes. Material and methods: This study was a retrospective cohort analysis conducted on 27 DAVF patients from 2015 to 2023 who presented at Aga Khan University Hospital, Karachi. We examined the fistula types, clinical and technical success rates, complications, recurrence and the presence of concurrent CVST or TSS. Results: Complete clinical and technical success rates were 44% and 63%, respectively. The rates of complications and recurrence were 18.5% and 19%, respectively. The presence of thrombotic associations (CVST and TSS occlusion) was associated with significantly lower clinical success rates in our cohort. Type II Cognard fistulas were significantly associated with the presence of CVST and TSS occlusion (p = 0.003 and p = 0.044 respectively) as well as lower clinical success as compared to type IV fistulas. Conclusions: Our findings advocate for comprehensive recognition of thrombotic associations of DAVFs and their potential integration into classification systems to better determine prognostic outcomes. Large-scale multi-centre studies are required to validate these associations further and guide treatment strategies.