Nongalenic Arteriovenous Fistulas: History of Treatment and Technology

Kristen Upchurch, MD; Lei Feng, MD, PhD; Gary R. Duckwiler, MD; John G. Frazee, MD; Neil A. Martin, MD; Fernando Viñuela, MD

Disclosures

Neurosurg Focus. 2006;20(6) 

In This Article

Historical Classification

Due to their rarity and to the difficulty in accurately de fining their angioarchitecture in the preangiography era, nongalenic AVFs typically were not recognized as a distinct category of vascular lesion in historical classifications. Nongalenic AVFs were grouped by Walter Dandy[8] in his 1928 series with the general class of vascular malformations that he called "arteriovenous aneurysms."[26] Later, in a classic 1945 review of intracranial vascular lesions, Nor an[26] distinguished the categories of "cerebral varix" and "arteriovenous angioma," with no exact fit for nongalenic AVFs in his extensive classification system. When McCormick[24] published his streamlined classification of vascular malformations in 1966, he proposed the separate categories of "varix" and "arteriovenous malformation (angioma)" without explicitly describing nongalenic AVFs, which are neither simply varices nor classic AVMs. In the past, given their infrequency and the absence of a specific classification category, nongalenic AVFs were often grouped with AVMs in clinical series. As will be described, the capacity of modern angiography to define angioarchitecture precisely has allowed the distinction of nongalenic AVFs from AVMs, adding a category to the classification of cerebrovascular lesions and there by improving the diagnosis and treatment of these lesions.

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