Angiography in the investigation of spinal dural arteriovenous fistula. A protocol with application of the venous phase.

The authors present their protocol for spinal angiography in their investigation of dural arteriovenous fistula (DAVF). The protocol has been used in approximately 120 patients from 1983 to the present at Bicetre Hospital. The approach is based on the fact that venous congestion is responsible for the myelopathy of DAVF. If the venous phase of the spinal circulation is normal, this alone rules out DAVF as the cause of the patient's symptoms. If there is stasis in the spinal circulation, this is consistent with DAVF, and thus complete spinal angiography is necessary. Complete angiography includes the selective intercostal arteries, including the lateral sacrals, as well as the supply to the cervical cord and posterior fossa.