Sacral Dural Arteriovenous Fistula: when standard spinal angiography fails

This presentation from LINNC Americas 2026 discusses a complex case of a 67-year-old male patient with progressive paraparesis and bladder dysfunction caused by a dural arteriovenous fistula (AVF).

Despite initial negative spinal angiographies and advanced non-invasive imaging, the fistula was difficult to locate and was ultimately identified through a modified spinal angiography protocol including iliac artery study, finally leading to the discovery of a sacral dAVF. The presentation emphasizes the challenges in diagnosing spinal AVFs, especially in uncommon locations such as the sacral region, and highlights the importance of including iliac arteries in angiographic evaluation.

Treatment involved endovascular embolization with squid 12, resulting in significant clinical improvement and radiologic resolution.