Abstract Details

Title “Sacral Vein Sign” on MRI with Typical Findings of Spinal Arteriovenous Fistula Suggests a Pelvic Arteriovenous Fistula with Retrograde Spinal Venous Drainage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 1-003

Objective We describe three cases of pelvic arteriovenous fistula (AVF) with perimedullary venous drainage where identification of an enlarged sacral draining vein in the thecal sac on MRI suggested location of AVF in the pelvis.

Background Typical MRI findings of dilated vascular structures on the surface of the lower cord and intramedullary hyperintensity on T2-weighted images, suggest a diagnosis of spinal AVF. Spinal angiography (SA) is performed to localize and characterize the type of AVF for treatment. However, SA can be an extensive procedure due to numerous arteries supplying the cord. In a rare type of AVF, the fistula can be located in the pelvis with retrograde venous drainage via a sacral medullary vein to the perimedullary venous plexus. MR angiogram, which usually focuses on the lower thoracic region, may not identify the fistula. The fistula may be missed unless pelvic blood vessels are injected as a last resort to identify the AVF.

Design/Methods After review of MRI and SA of 14 cases of spinal AVF from 2000 to 2018, we identified and describe 3 cases in which AVF was located in the pelvis. All three patients were male (ages 60, 61, and 67 years) and presented with progressive weakness, sensory changes, or pain and showed typical findings of spinal AVF on MRI. Pelvic AVF was only identified after injecting 19, 13, and 50 spinal arteries, respectively (3rd patient had 2 prior negative SA).

Results In all 3 cases, a dilated sacral vein was identified on MRI in the sacral thecal sac that was not present in the other 11 spinal AVF cases.

Conclusions With typical finding of spinal AVF, MRI of the lumbosacral spine should be critically reviewed for presence of a dilated sacral vein indicating pelvic AVF. In such cases, SA should begin with injection of the internal iliac artery.

Authors/Disclosures
Rohit Swarnkar, MD (SUNY Health Science Center, Upstate) PRESENTER	No disclosure on file
Eufrosina I. Young, MD (Upstate University Hospital)	The institution of Dr. Young has received research support from Mitsubishi Tanabe Pharma America.
	No disclosure on file
	No disclosure on file

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