Mechanism of the formation of dural arteriovenous fistula: the role of the emissary vein.

E. S Miyachi, T. Izumi, N. Matsubara, T. Naito, K. Haraguchi, T. Wakabayashi

研究成果: ジャーナルへの寄稿学術論文査読

41 被引用数 (Scopus)

抄録

Dural arteriovenous fistula (DAVF) can be separated into two types: DAVF which drains through an affected sinus (sinus type) and DAVF with direct reflux to the cortical vein (non-sinus type). The present report attempted to clarify the mechanism of formation and development of DAVF focusing on the emissary vein (EV) hypothesis.First, inflammation occurs at the penetrating point of the EV on the dura due to idiopathic or secondary causes. Local inflammatory reactions induce vessel dilatation and neovascularization, and subsequently create arteriovenous (AV) connections on the arteriole level. Although EV communicating with dural arteries might play a role as draining routes at first, they start to degrade due to compression of enlarged emissary arteries or to a hemodynamic shift to the drainage pathway of least resistance. Following the occlusion of drainage pathway through EV into the sinus or cortical veins may form, resulting in clinically detectable DAVF. The AV shunt then expands to the surrounding dura associated with recruitment of feeders from distant sites induced by expression of angiogenetic factors and a shift in the hemodynamic balance. In sinus type DAVF, the sinus is progressively compartmentalized and finally occludes due to thrombogenesis with activated coagulopathy or to hemodynamic hypertrophy of the sinus wall. This progression results in the mature, aggressive DAVF with drainage impairments. Previous mechanistic hypotheses focusing on sinus hypertension and sinus thromboses cannot explain the pathogenesis of non-sinus type of DAVF. Although the etiology of DAVF may be concerned by the thrombo-occlusive change of sinus, the unique theory presented in this report may enable an understanding of the common etiology of both types of DAVF.

本文言語英語
ページ(範囲)195-202
ページ数8
ジャーナルInterventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences
17
2
DOI
出版ステータス出版済み - 06-2011
外部発表はい

All Science Journal Classification (ASJC) codes

  • 放射線学、核医学およびイメージング
  • 臨床神経学
  • 循環器および心血管医学

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