Multimodal MRI diagnosis and transvenous embolization of a basicranial emissary vein dural arteriovenous fistula:A case report

A dural arteriovenous fistula(DAVF) is an abnormal linkage connecting the arterial and venous systems within the intracranial dura mater. A basicranial emissary vein DAVF drains into the cavernous sinus and the ophthalmic vein, similar to a cavernous sinus DAVF. Precise preoperative identification of the DAVF location is a prerequisite for appropriate treatment. Treatment options include microsurgical disconnection, endovascular transarterial embolization(TAE), transvenous embolization(TVE), or a combination thereof. TVE is an increasingly popular approach for the treatment of DAVFs and the preferred approach for skull base locations, due to the risk of cranial neuropathy caused by dangerous anastomosis from arterial approaches. Multimodal magnetic resonance imaging(MRI) can provide anatomical and hemodynamic information for TVE. The therapeutic target must be precisely embolized in the emissary vein, which requires guidance via multimodal MRI. Here, we report a rare case of successful TVE for a basicranial emissary vein DAVF, utilizing multimodal MRI assistance. The fistula had vanished, pterygoid plexus drainage had improved, and the inferior petrosal sinus had recanalized, as observed on 8-month follow-up angiography. Symptoms and signs of double vision, caused by abduction deficiency, disappeared. Detailed anatomic and hemodynamic assessment by multimodal MRI is the key to guiding successful diagnosis and treatment.

Prosthetic venous valves for chronic venous insufficiency:Advancements and future design directions

With the serious aging population and lifestyle changes,chronic venous insufficiency accounts for approximately 25.95%of the population,which may lead to lower limb edema and leg heaviness,as well as severe infections of skin ulcers that can result in sepsis and necessitate amputation.Conservative treatment and other supportive measures can only slow the disease's progression but are unable to drastically reverse it;surgical interventions are rarely used due to the high risk of catastrophic postoperative consequences.As one of the most promising minimally invasive therapies,percutaneous prosthetic valve replacement has emerged in light of this situation,providing novel alternatives for patients with deep venous valve insufficiency.We reviewed the historical prosthetic venous valve designs,including their structure and materials,animal evaluation models,and assessment criteria.On the basis of the findings from in vitro tests,animal studies,and clinical trials,we summarized the major challenges and potential solutions for the development of advanced prosthetic venous valves.