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Introduction Complete endovascular sinus occlusion has been used as a curative strategy for selected dural arteriovenous fistulas (dAVFs). The true efficacy and safety profile of this approach have not been systematically quantified. This review aimed to evaluate angiographic outcomes and complication rates associated with complete endovascular sinus occlusion for dAVFs.Methods A systematic search of PubMed, Web of Science, and Embase was performed from database inception to February 2026. Studies reporting patients with dAVFs treated with intentional complete endovascular sinus occlusion and providing extractable outcome data were included. Carotid-cavernous fistulas, surgical-only sinus sacrifice, review articles, and studies without relevant outcome data were excluded. Outcomes were pooled and synthesized descriptively.Results Eighty-seven studies comprising 536 patients treated with complete endovascular sinus occlusion were included. The majority of sacrificed sinuses involved the transverse-sigmoid sinus complex. The sinus was initially thrombosed or isolated in 30% of patients and most sacrificed sinuses were non-dominant (95%). Immediate complete angiographic obliteration was achieved in 77% of patients. At last follow-up, recurrence occurred in 7% and retreatment was required in 6% of patients. Procedure-related complications potentially attributable to sinus occlusion occurred in 6% of patients, including hemorrhagic infarction, venous thrombosis extension, cranial nerve deficits, otologic complications, increased intracranial pressure, and mortality.Conclusion Although complete endovascular sinus occlusion remains an effective curative strategy for selected patients with dAVFs, this technique carries a measurable risk of serious complications. Careful selection based on venous anatomy and hemodynamic assessment is essential to mitigate the risk of serious adverse events.Disclosures V. El-Hajj: None. M. Gharios: None. J. El Choueiri: None. E. Atallah: None.