Published online Oct 16, 2024. doi: 10.12998/wjcc.v12.i29.6314
Revised: July 27, 2024
Accepted: August 8, 2024
Published online: October 16, 2024
Processing time: 116 Days and 0.7 Hours
In general, venous aneurysm associated with dural arteriovenous fistula (dAVF) is considered to be developed under long standing venous hypertension and manifested as venous ectasia of draining vein itself. However, discrete saccular shaped venous aneurysm without angiographic evidence of venous hypertension arising from the draining vein, like cerebral arterial aneurysm, is quite rare and its pathomechanism remains unclear in patients with dAVF.
In this report, we present two cases of ruptured saccular venous aneurysms associated with dAVF without venous hypertension or venous ectasia. In both cases, significant curve or stenosis is observed in draining vein, which is located in just distal portion of the venous aneurysms. These aneurysms were successfully treated with a transarterial embolization. Underlying mechanism of venous aneurysms in these cases is discussed.
Although there is little doubt that hemodynamic stress has a critical role in the development of venous aneurysms in patients with dAVF, preceding venous hypertension or venous ectasia is not necessary for development and enlargement of venous aneurysms. Considering the significant risk of rupture, a careful review of draining vein features including tortuosity or stenosis is needed, especially in venous aneurysms without evidence of venous hypertension.
Core Tip: Venous aneurysms associated with dural arteriovenous fistula (dAVF) have been generally considered to be developed in the setting of venous hypertension or venous ectasia. However, saccular venous aneurysm in patients with dAVF could develop without preceding venous ectasia or venous hypertension and this situation is very rare. So, its pathomechanism remains unclear in patients with dAVF. In this report, we present rare cases of venous aneurysms in the absence of venous hypertension, and describe underlying unique angiographic features; presence of curved or stenotic portion within long and tortuous draining vein.