Analysis of spinal angiograms that missed diagnosis of spinal vascular diseases with venous hypertensive myelopathy: the
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ORIGINAL ARTICLE
Analysis of spinal angiograms that missed diagnosis of spinal vascular diseases with venous hypertensive myelopathy: the non‑technical factors Tianhao Xie1 · Li Pan1 · Ming Yang1 · Zhaoxi Xu1 · Tao Wu2 · He Huang1 · Ming Li3 · Lianting Ma1 Received: 8 August 2019 / Revised: 30 January 2020 / Accepted: 11 April 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Spinal DSA is the “gold standard” technique to identify the spinal vascular diseases with venous hypertensive myelopathy (VHM). However, sometimes spinal DSA can find nothing in patients with confirmed spinal vascular anomalies. Many of the reasons are avoidable technical factors. Nevertheless, there are also some non-technical factors. The objective of this study was to identify the non-technical factors. Methods The cause of the missed findings was found as the non-technical factors in 14 patients. The clinical records and radiological findings of the 14 patients were reviewed. Results The so-called standard spinal angiography can found nothing in the 14 patients. Additional angiography was performed and detected the lesions. Eight patients were found lesions supplied by carotid arteries or iliac arteries, including 2 cranial DAVF with internal carotid artery blood supply, 3 cranial DAVF with external carotid artery blood supply and 2 pelvic AVF with internal iliac artery blood supply and 1 pelvic AVM with internal iliac artery blood supply. Six patients were caused by stenosis of spinal draining vein, including 3 stenosis of the third lumbar veins and 3 stenosis of left renal veins combined with the reno–spinal trunk. Conclusions In order to avoid the missed findings of spinal vascular diseases with VHM, the technical factors should be reduced by performing a rigorous comprehensive angiography. To reduce the non-technical factors, the angiography of the internal iliac artery, the carotid artery systems and spinal draining veins should be performed in some special cases if the routine spinal angiography can find nothing. Keywords Myelopathy · Venous hypertension · Spinal angiography · Spinal cord Abbreviations AVF Arteriovenous fistula; DAVF Dural arteriovenous fistula; VHM Venous hypertensive myelopathy AVM Arteriovenous malformation
* Lianting Ma [email protected] 1
Department of Neurosurgery, Central Theater General Hospital of Chinese PLA, No. 627 Wuluo Road, Wuhan, China
2
Department of Neurosurgery, Shenzhen Hospital of Peking University, Shenzhen, China
3
Department of Neurosurgery, Shenzhen Hospital, University of the Chinese Academy of Sciences, Shenzhen, China
Introduction Spinal venous hypertensive myelopathy (VHM) is a syndrome which results from various vascular lesions of spinal cord, spine or paraspinal structures. These vascular lesions can cause stagnation of the blood flow leading to impairment of spinal cord venous drainage [1, 2]. Venous congestion can be transmitted to the valveless veins of the spinal cord, resulting in concomitant decrease in perfusion [3, 4].
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