Endovascular Therapeutic Considerations for Cervical Epidural Arteriovenous Fistula

A cervical epidural arteriovenous fistula (CEAVF) is an uncommon arteriovenous shunt in the epidural space. CEAVFs can be classified into type A and type B. Type B can be further divided into two subtypes: B1 and B2. Endovascular treatment (EVT) has shown clinical utility. However, deep understanding of the role of EVT is necessary due to the rarity and intricate pathomechanics of CEAVFs. Therefore, a systematic review was performed by searching the PubMed database. The clinical data were extracted. A total of 20 articles reporting 22 patients with a single CEAVF were identified. The patients were 42.3 ± 17.6 years old, and 42.9% were female. Type B1 accounted for 81.8% of CEAVFs, and 73.7% of CEAVFs with exact location data were at the C4–7 levels. Multiple feeding arteries per arteriovenous fistula were present in 72.8% of CEAVFs. The vertebral artery was the most common feeding artery, accounting for 67% of CEAVFs. The draining vein had a venous pouch in 86.4% of CEAVFs. When EVT was performed, complete obliteration was obtained in 68.2% of CEAVFs. During follow-up, 78.9% of patients made a complete or significant recovery, and 21.1% showed moderate improvement. Therefore, EVT is effective for CEAVFs. Complete obliteration of nearly 70% of CEAVFs can be achieved via EVT. In this study, nearly 80% of patients made a complete or significant recovery during follow-up.