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Peripheral arteriovenous malformations with a dominant outflow vein: results of ethanol embolization.

Cho SK, Do YS, Kim DI, Kim YW, Shin SW, Park KB, Ko JS, Lee AR, Choo SW, Choo IW - Korean J Radiol (2008 May-Jun)

Bottom Line: Ethanol embolization was considered as an effective procedure in all patients.Thirteen (68%) of 19 patients were cured and six displayed improvement.Five complications (three events of a distal embolism and one event each of a urinary bladder necrosis and a brain infarct related to the accidental cannulation of the common carotid artery during insertion of the Swan-Ganz catheter) were major and three complications (skin necrosis) were minor.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Objective: To assess retrospectively the treatment results of ethanol embolization of peripheral arteriovenous malformations (AVMs) with a dominant outflow vein (DOV).

Materials and methods: Nineteen patients who had peripheral AVMs with a DOV were enrolled in this study (mean age, 29.7 years; range, 15-42 years). Fifty-one ethanol embolizations (mean, 2.7; range, 1-8) were performed by direct puncture (n = 29), the transarterial approach (n = 13), the transvenous approach (n = 5), or a combination of methods (n = 4) under general anesthesia. Coil and/or core-removed guide wire embolization of the DOV or another flow occlusion technique (i.e., use of an external pneumatic pressure cuff) to achieve vascular stasis were required in all patients during ethanol embolization. Clinical follow-up (mean, 22.2 months; range, 1-53 months) was performed for all patients, and imaging follow-up (mean, 22.1 months; range, 2-53 months) from the last treatment session was performed for 14 patients. The therapeutic outcome (cure, improvement, no change, or aggravation) was assessed according to the clinical response and the degree of devascularization at angiography.

Results: Ethanol embolization was considered as an effective procedure in all patients. Thirteen (68%) of 19 patients were cured and six displayed improvement. Three of six patients with improvement needed further treatment sessions for residual AVMs. Four patients (21%) experienced a total of eight complications. Five complications (three events of a distal embolism and one event each of a urinary bladder necrosis and a brain infarct related to the accidental cannulation of the common carotid artery during insertion of the Swan-Ganz catheter) were major and three complications (skin necrosis) were minor.

Conclusion: Peripheral AVMs with a DOV can be effectively treated with a high cure rate by the use of ethanol embolization alone or in conjunction with the use of coil and/or core-removed guide wire embolization.

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Related in: MedlinePlus

Diagram and angiographic example of peripheral arteriovenous malformations with dominant outflow vein.A. Peripheral arteriovenous malformations with dominant outflow vein have arteriovenous shunts (S) between multiple arterial components (A) and dilated venous component (V) of nidus. Dilated venous component of nidus appears as initial part of large outflow vein on angiography.B, C. Arterial (B) and venous (C) phases of selective posteroanterior angiogram of arteriovenous malformation with dominant outflow vein in left forearm show multiple arterial feeders that shunt into wall of large dilated outflow vein (arrows).
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Figure 1: Diagram and angiographic example of peripheral arteriovenous malformations with dominant outflow vein.A. Peripheral arteriovenous malformations with dominant outflow vein have arteriovenous shunts (S) between multiple arterial components (A) and dilated venous component (V) of nidus. Dilated venous component of nidus appears as initial part of large outflow vein on angiography.B, C. Arterial (B) and venous (C) phases of selective posteroanterior angiogram of arteriovenous malformation with dominant outflow vein in left forearm show multiple arterial feeders that shunt into wall of large dilated outflow vein (arrows).

Mentions: From November 1996 to November 2006, 111 consecutive patients with inoperable peripheral AVMs underwent staged ethanol embolizations. As in previous studies (9, 12, 14), AVMs with a DOV were defined when multiple arteriolar components of the nidus shunted into a dilated venous component of the nidus that was identified as the part of a large outflow vein on angiography (Fig. 1). According to the angiographic classification proposed by Cho et al. (12), all the angiographic studies of the 111 patients were retrospectively reviewed by consensus of two radiologists. Nineteen patients were considered to have AVMs with a DOV.


Peripheral arteriovenous malformations with a dominant outflow vein: results of ethanol embolization.

Cho SK, Do YS, Kim DI, Kim YW, Shin SW, Park KB, Ko JS, Lee AR, Choo SW, Choo IW - Korean J Radiol (2008 May-Jun)

Diagram and angiographic example of peripheral arteriovenous malformations with dominant outflow vein.A. Peripheral arteriovenous malformations with dominant outflow vein have arteriovenous shunts (S) between multiple arterial components (A) and dilated venous component (V) of nidus. Dilated venous component of nidus appears as initial part of large outflow vein on angiography.B, C. Arterial (B) and venous (C) phases of selective posteroanterior angiogram of arteriovenous malformation with dominant outflow vein in left forearm show multiple arterial feeders that shunt into wall of large dilated outflow vein (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627257&req=5

Figure 1: Diagram and angiographic example of peripheral arteriovenous malformations with dominant outflow vein.A. Peripheral arteriovenous malformations with dominant outflow vein have arteriovenous shunts (S) between multiple arterial components (A) and dilated venous component (V) of nidus. Dilated venous component of nidus appears as initial part of large outflow vein on angiography.B, C. Arterial (B) and venous (C) phases of selective posteroanterior angiogram of arteriovenous malformation with dominant outflow vein in left forearm show multiple arterial feeders that shunt into wall of large dilated outflow vein (arrows).
Mentions: From November 1996 to November 2006, 111 consecutive patients with inoperable peripheral AVMs underwent staged ethanol embolizations. As in previous studies (9, 12, 14), AVMs with a DOV were defined when multiple arteriolar components of the nidus shunted into a dilated venous component of the nidus that was identified as the part of a large outflow vein on angiography (Fig. 1). According to the angiographic classification proposed by Cho et al. (12), all the angiographic studies of the 111 patients were retrospectively reviewed by consensus of two radiologists. Nineteen patients were considered to have AVMs with a DOV.

Bottom Line: Ethanol embolization was considered as an effective procedure in all patients.Thirteen (68%) of 19 patients were cured and six displayed improvement.Five complications (three events of a distal embolism and one event each of a urinary bladder necrosis and a brain infarct related to the accidental cannulation of the common carotid artery during insertion of the Swan-Ganz catheter) were major and three complications (skin necrosis) were minor.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Objective: To assess retrospectively the treatment results of ethanol embolization of peripheral arteriovenous malformations (AVMs) with a dominant outflow vein (DOV).

Materials and methods: Nineteen patients who had peripheral AVMs with a DOV were enrolled in this study (mean age, 29.7 years; range, 15-42 years). Fifty-one ethanol embolizations (mean, 2.7; range, 1-8) were performed by direct puncture (n = 29), the transarterial approach (n = 13), the transvenous approach (n = 5), or a combination of methods (n = 4) under general anesthesia. Coil and/or core-removed guide wire embolization of the DOV or another flow occlusion technique (i.e., use of an external pneumatic pressure cuff) to achieve vascular stasis were required in all patients during ethanol embolization. Clinical follow-up (mean, 22.2 months; range, 1-53 months) was performed for all patients, and imaging follow-up (mean, 22.1 months; range, 2-53 months) from the last treatment session was performed for 14 patients. The therapeutic outcome (cure, improvement, no change, or aggravation) was assessed according to the clinical response and the degree of devascularization at angiography.

Results: Ethanol embolization was considered as an effective procedure in all patients. Thirteen (68%) of 19 patients were cured and six displayed improvement. Three of six patients with improvement needed further treatment sessions for residual AVMs. Four patients (21%) experienced a total of eight complications. Five complications (three events of a distal embolism and one event each of a urinary bladder necrosis and a brain infarct related to the accidental cannulation of the common carotid artery during insertion of the Swan-Ganz catheter) were major and three complications (skin necrosis) were minor.

Conclusion: Peripheral AVMs with a DOV can be effectively treated with a high cure rate by the use of ethanol embolization alone or in conjunction with the use of coil and/or core-removed guide wire embolization.

Show MeSH
Related in: MedlinePlus