Usefulness and Stability of Intraoperative Digital Subtraction Angiography Using the Transradial Route in Arteriovenous Malformation Surgery

• Published in: World neurosurgery Vol. 111; pp. e799 - e805
• Main Authors: Yoon, Wonki, Kim, Hoon, Kim, Young Woo, Kim, Seong Rim, Park, Ik Seong
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2018
• Subjects: Arteriovenous malformation; Digital subtraction angiography; Intraoperative angiography; Nidus removal; Digital subtraction angiography; CT; DSA; Nidus removal; ICGA; AVM; iDSA; iTRCA; TRCA; Arteriovenous malformation; Intraoperative angiography; ICH
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.12.164

Digital subtraction angiography is the gold standard to confirm complete removal of an arteriovenous malformation (AVM) nidus. However, the transfemoral approach requires specialized instrumentation and is cumbersome and difficult to perform with the patient in the prone or decubitus position. We report the use of intraoperative digital subtraction angiography (iDSA) with the transradial approach and examine its usefulness and safety.
We retrospectively reviewed clinical features, radiologic images, surgical findings, and iDSA findings of patients with AVM who underwent surgery for nidus removal. Transradial iDSA was performed within 30 minutes for patients who required angiographic confirmation after AVM resection. This procedure was simple with the radial arterial line for blood pressure monitoring used as digital subtraction angiography catheter access route.
Transradial iDSA was performed in 23 patients. Twelve patients were not in the general supine position during neurosurgery; 7 patients were operated on in prone position, and 5 patients were operated on in the park bench position. Remnant nidus was identified by iDSA in 2 patients, and additional measures were required.
Intraoperative cerebral angiography during surgery for cerebral AVM could be performed safely via the transradial approach. This approach showed several merits in terms of easy access; no extra requirements, such as preoperative sheath implantation, anticoagulation during the surgery, or a radiolucent table; and usefulness in any surgical position. Further studies using this approach and comparison with the transfemoral approach are necessary.
•Intraoperative angiography is a useful tool for completeness of AVM surgery.•We report the use of iDSA with the transradial approach and examine its usefulness and safety.•This approach demonstrated easy access, no extra requirements, and usefulness in prone or lateral surgical position.