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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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23-year-old woman with pain at left calf (patient 5).A, B. Arterial (A) and venous (B) phases of pretreatment posteroanterior angiogram show multiple feeding arteries (arrowheads) with plexiform appearance and dilated outflow vein (arrows).C. Multiple coils (arrows) were placed into dilated outflow vein through direct puncture approach, and then 19 mL of absolute ethanol was injected through needle.D. Final posteroanterior angiogram shows complete obliteration of arteriovenous malformation. There was no evidence of recurrence at 40-month imaging and clinical follow-up (data not shown).
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Figure 2: 23-year-old woman with pain at left calf (patient 5).A, B. Arterial (A) and venous (B) phases of pretreatment posteroanterior angiogram show multiple feeding arteries (arrowheads) with plexiform appearance and dilated outflow vein (arrows).C. Multiple coils (arrows) were placed into dilated outflow vein through direct puncture approach, and then 19 mL of absolute ethanol was injected through needle.D. Final posteroanterior angiogram shows complete obliteration of arteriovenous malformation. There was no evidence of recurrence at 40-month imaging and clinical follow-up (data not shown).

Mentions: The treatment results of ethanol embolization for the 19 patients with peripheral AVMs with a DOV are presented in Table 1. During the 51 sessions of ethanol embolizations, the amount of ethanol used ranged from 2 to 74 mL in a single session (mean: 34.4 mL, median: 36 mL). Flow occlusion techniques to achieve vascular stasis were applied in all patients, but not in all embolization sessions. Flow occlusion techniques were applied in 37 of 51 embolization sessions, including coil and/or core-removed guide wire embolization of the outflow vein in 20 sessions, application of an intravascular occlusion balloon catheter in two sessions, both of the aforementioned methods in three sessions, or application of an external pneumatic cuff in 12 sessions. For 14 embolization sessions, ethanol embolization was performed without an application of flow occlusion techniques as the residual AVM was small or because the application of flow occlusion techniques could induce reflux of ethanol into the adjacent normal arteries. Coil and/or core-removed guide wire embolization of the outflow vein prior to ethanol injection was performed in 13 (68%) of 19 patients. Coil embolization was performed in seven patients (Fig. 2), core-removed guide wire embolization was performed in two patients, and both coil embolization and core-removed guide wire embolization was performed in four patients. The direct puncture approach was used in 31 of 51 embolization sessions, the transarterial approach was used in 16 sessions, and the transvenous approach was used in eight sessions (multiple approaches in four sessions). Embolization through direct puncture and/or transvenous approaches was performed in 17 of 19 AVMs with a DOV. In the other two patients, ethanol embolization was performed only through a transarterial approach.


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)

23-year-old woman with pain at left calf (patient 5).A, B. Arterial (A) and venous (B) phases of pretreatment posteroanterior angiogram show multiple feeding arteries (arrowheads) with plexiform appearance and dilated outflow vein (arrows).C. Multiple coils (arrows) were placed into dilated outflow vein through direct puncture approach, and then 19 mL of absolute ethanol was injected through needle.D. Final posteroanterior angiogram shows complete obliteration of arteriovenous malformation. There was no evidence of recurrence at 40-month imaging and clinical follow-up (data not shown).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: 23-year-old woman with pain at left calf (patient 5).A, B. Arterial (A) and venous (B) phases of pretreatment posteroanterior angiogram show multiple feeding arteries (arrowheads) with plexiform appearance and dilated outflow vein (arrows).C. Multiple coils (arrows) were placed into dilated outflow vein through direct puncture approach, and then 19 mL of absolute ethanol was injected through needle.D. Final posteroanterior angiogram shows complete obliteration of arteriovenous malformation. There was no evidence of recurrence at 40-month imaging and clinical follow-up (data not shown).
Mentions: The treatment results of ethanol embolization for the 19 patients with peripheral AVMs with a DOV are presented in Table 1. During the 51 sessions of ethanol embolizations, the amount of ethanol used ranged from 2 to 74 mL in a single session (mean: 34.4 mL, median: 36 mL). Flow occlusion techniques to achieve vascular stasis were applied in all patients, but not in all embolization sessions. Flow occlusion techniques were applied in 37 of 51 embolization sessions, including coil and/or core-removed guide wire embolization of the outflow vein in 20 sessions, application of an intravascular occlusion balloon catheter in two sessions, both of the aforementioned methods in three sessions, or application of an external pneumatic cuff in 12 sessions. For 14 embolization sessions, ethanol embolization was performed without an application of flow occlusion techniques as the residual AVM was small or because the application of flow occlusion techniques could induce reflux of ethanol into the adjacent normal arteries. Coil and/or core-removed guide wire embolization of the outflow vein prior to ethanol injection was performed in 13 (68%) of 19 patients. Coil embolization was performed in seven patients (Fig. 2), core-removed guide wire embolization was performed in two patients, and both coil embolization and core-removed guide wire embolization was performed in four patients. The direct puncture approach was used in 31 of 51 embolization sessions, the transarterial approach was used in 16 sessions, and the transvenous approach was used in eight sessions (multiple approaches in four sessions). Embolization through direct puncture and/or transvenous approaches was performed in 17 of 19 AVMs with a DOV. In the other two patients, ethanol embolization was performed only through a transarterial approach.

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