Intermittent Balloon Occlusion Spurs Epidural AVF Closure When Catheterization Fails

Complete occlusion of a paravertebral epidural AVF confirmed at 18 months after intermittent balloon occlusion without embolic agents. Immediate flow reduction occurred after four 10-min inflations (cumulative 40 min). A bailout when superselective access is not feasible.

• Intermittent balloon occlusion across the origins of minute feeders induced hemodynamic alterations that led to spontaneous fistula thrombosis.
• Preprocedural collateral circulation assessment and intraoperative neurophysiologic monitoring are essential for safety.
• This is a highly selected bailout maneuver and not a routine alternative to embolization; only a single case is reported.

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