Recurrence of initial angiographic occlusion in intracranial dural arteriovenous fistulas.

OBJECTIVE

Recurrence after an initial angiography-determined cure of dural arteriovenous fistula (DAVF) has been reported, with risk factors identified in a few studies; however, some findings remain controversial. The objective of this study was to evaluate a large cohort of patients with DAVFs to estimate the recurrence rate and identify factors influencing recurrence.

METHODS

Patient data for this study were derived from the Dural Arteriovenous Fistula Research and Management in China (DREAM-INI) database, compiled from a single-center retrospective study conducted in China. This analysis included only patients in whom an immediate complete cure was achieved who had subsequent angiographic follow-up. Two patient groups were compared: patients in whom a sustained durable cure was achieved and those who experienced recurrence following the initial cure. In addition to comparing baseline characteristics and follow-up results, potential risk factors for recurrence were examined and a time-to-recurrence analysis was performed.

RESULTS

Among the 1101 patients included in the DREAM-INI dataset, 510 met the inclusion criteria for this study. Of these, 41 patients with an initially cured DAVF had 47 recurrence events; 48.8% developed new fistulas at distant sites, 36.6% had in situ recurrence, and 14.6% had both types of recurrence. The overall recurrence rate was 8.0%, with anticipated recurrence rates of 13.9% at 36 months and 24.1% at 105 months. Recurrence was more frequently observed in Borden type II DAVFs. Identified risk factors for recurrence included age < 45 years, a transverse-sigmoid sinus location, multiple fistulae, pial arterial supply, and venous congestion.

CONCLUSIONS

DAVF recurrence can be classified as in situ recurrence and recurrence at other sites, both of which are closely linked to unresolved venous hypertension and the previously masked portion of the fistula. Risk factors for recurrence included age younger than 45 years, a transverse-sigmoid sinus location, multiple fistulae, pial arterial supply, and venous congestion. All patients with cured DAVFs, particularly those with identified risk factors, were advised to undergo angiographic follow-up beyond 1 year.