Results of treatment of arteriovenous fistulae with the Debrun technique.

In a series of 54 caroticocavernous fistulae and eight vertebrovertebral fistulae, clinical cures were obtained in 46 of the caroticocavernous fistulae and in all of the vertebrovertebral fistulae using the Debrun coaxial catheter detachable balloon technique. Most low vertebrovertebral and about half of the posteriorly opening caroticocavernous fistulae were successfully treated by the safe transvenous approach. Technical difficulties were not infrequent but were overcome in most cases. In nine cases the artery was occluded with the fistula and in two others minimal residual shunt persisted, progressing in one to a symptomatic aneurysm. Five caroticocavernous fistulae in which the balloon could not be satisfactorily sited were not closed, and another caroticocavernous fistula closed spontaneously after a failed transvenous approach. Displacement of balloons during detachment reopened two caroticocavernous fistulae. One of these had to be closed by transcranial surgery; the other balloon embolized the middle cerebral artery, was surgically removed, and a mild hemiparesis persisted. Premature balloon detachment in a grossly atheromatous artery caused the only other major complication and contributed to the death of an 87-year-old patient. The most frequent complications were transient ophthalmoplegias. Minor modifications to the catheter system should reduce the incidence of such catastrophes and complications.