THE USE OF ELECTROLYTICALLY DETACHABLE COILS IN TREATING HIGH-FLOW ARTERIOVENOUS-FISTULAS

BACKGROUND AND PURPOSE: High-flow arteriovenous fistulas (AVFs) are co mmonly treated by using an endovascular approach with a variety of mat erials. The use of a Guglielmi electrolytically detachable coil (GDC) provides the ability to reposition or remove the coil if its position is not optimal and may minimize the risk of coil migration or distal e mbolization. This study reports our experience in using these coils al one or in combination with other materials in the treatment of intracr anial and cervical high-how fistulas. METHODS: Twelve patients with AV Fs were treated with GDCs via the transvenous or transarterial-transfi stulous routes. The six dural AVFs treated transvenously were also tre ated transarterially, and the GDCs were combined with fibered coils in three of these patients and in two other patients with pial AVFs, All patients have been clinically followed up for 12 to 48 months (mean, 28 months). RESULTS: Angiographic obliteration was obtained in all 12 patients. The fistulas have remained closed in 11 patients, as ascerta ined by angiographic confirmation in two patients and by clinical exam ination in nine patients. The one patient with recurrence experienced neurologic improvement and refused further treatment. GDCs required re positioning before detachment in seven patients, and no migration occu rred after detachment. CONCLUSION: GDCs are useful for the treatment o f high-now AVFs, They afford more control in the placement of coils an d may provide an anchoring point for more thrombogenic materials.