Selection of Guiding Catheter Based on the Anatomical Structures when Performing TVE to Treat an Anterior Condylar Confluence Dural AVF

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Objective: For transvenous embolization (TVE) of dural arteriovenous fistulae (dAVF) in the anterior condylar confluence (ACC), stable placement of a guiding catheter is important to approach the ACC from the jugular bulb (JB) with a microcatheter. We document our method and present a review of the literature.

Case Presentations: We used a 5-Fr internal mammary artery (IMA) catheter to guide the microcatheter into the ACC for coil embolization. In one patient, we placed the steeply angled tip of a 5-Fr IMA catheter into the entrance of the ACC from the JB, guided the microcatheter into the ACC, and performed coil embolization. In another patient, we created a coaxial setup by inserting a 5-Fr IMA catheter into a 6-Fr guiding catheter and advanced the tip of the IMA catheter from the JB into the ACC entrance in accordance with the angulation of the ACC entrance.

Conclusion: It is useful to select an IMA catheter based on anatomical structure when a direct approach from the JB to the ACC is required. Ours is the first report of an approach for TVE from the involved side using a guiding catheter adapted to the anatomical structure. We recommend the use of an IMA catheter adapted to the anatomical structures when a direct approach from the JB to the ACC is needed for TVE of dAVF in the ACC.