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Transradial approach in the treatment of a sacral dural arteriovenous fistula: a technical note
  1. Emanuele Orru1,
  2. Chun On Anderson Tsang2,
  3. Jesse M Klostranec3 and
  4. Vitor M Pereira4
  1. 1 Department of Interventional Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
  2. 2 Department of Surgery, The University of Hong Kong, Hong Kong, Hong Kong
  3. 3 Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
  4. 4 Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Emanuele Orru, surgeon.ema{at}


Sacral dural arteriovenous fistulas (SDAVFs) are rare, constituting no more than 10% of all spinal dural fistulas. They are most commonly fed by the lateral sacral artery (LSA), a branch of the internal iliac artery (IIA). Catheterization of this vessel requires either a crossover at the aortic bifurcation in cases of right femoral access or retrograde catheterization from the ipsilateral common femoral artery. We present the case of a 79-year-old man with tethered cord syndrome and a symptomatic SDAVF fed by two feeders from the left LSA. Spinal diagnostic angiography was made exceptionally challenging by an aorto-bi-iliac endograft, and selective catheterization of the left IIA was not possible. The patient could not undergo surgery due to multiple comorbidities, therefore embolization was considered the best approach. The procedure was carried out through a transradial access (TRA) with Onyx and n-butyl cyanoacrylate. The SDAVF was successfully treated and the patient made a full neurological recovery.

  • spinal cord
  • fistula
  • lumbosacral
  • liquid embolic material
  • spine

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  • Contributors All authors participated in the procedure and contributed to the manuscript drafting and review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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