High importance
Sep 21, 2026
To evaluate a staged embolisation strategy for treating spinal epidural arteriovenous fistula (SEDAVF) in a patient with a concurrent pulmonary arteriovenous malformation (PAVM).
The case involved coil embolisation of the PAVM followed by N-butyl-2-cyanoacrylate embolisation of the SEDAVF, carefully planned to mitigate risks associated with the patient's vascular anomalies.
The staged approach resulted in successful embolisation of both lesions without clinically evident complications, demonstrating the effectiveness of targeted treatment planning in complex cases involving multiple vascular shunts.
The study is a single case report, limiting the generalizability of results to broader clinical populations; further studies are needed to validate this approach in larger cohorts.
This case underscores the critical importance of individualized treatment strategies in patients with Hereditary Hemorrhagic Telangiectasia (HHT) and multiple arteriovenous malformations, particularly in minimizing the risk of embolic events during intervention.
A woman in her 80s was referred for evaluation and treatment of progressive paraparesis due to a suspected spinal arteriovenous shunt. During hospitalisation at the referring institution, she developed multiterritory embolic stroke, prompting investigation.Bilateral deep venous thrombosis and a large pulmonary arteriovenous malformation (PAVM) with a high-grade extracardiac right-to-left shunt were identified, supporting paradoxical embolism as the most likely mechanism. Spinal angiography confirmed a spinal epidural arteriovenous fistula (SEDAVF) with venous drainage into intradural spinal veins and the inferior vena cava.Because liquid embolic material used for SEDAVF treatment could potentially migrate into the inferior vena cava and reach the systemic circulation through the PAVM, a staged approach was adopted. Coil embolisation of the PAVM was performed, followed by N-butyl-2-cyanoacrylate embolisation of the SEDAVF without clinically evident complications.This case highlights the importance of treatment planning based on vascular anatomy and haemodynamics in patients with coexisting arteriovenous shunt lesions.