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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

28-year-old man with painful pulsating mass in left shoulder (patient 8).A, B. Arterial (A) and venous (B) phases of pretreatment posteroanterior angiogram show multiple feeding arteries (arrowheads) and huge dilated outflow vein (arrows). Note coil (open arrow) that was previously placed into feeding artery at another hospital.C. Arterial phase of left anterior oblique angiogram shows complete obliteration of arteriovenous malformations after three sessions of embolization with 40 mL, 55 mL, and 16 mL of absolute ethanol, respectively, by using direct puncture of dilated outflow vein. In every session, multiple core-removed guide wires were placed into outflow vein through direct puncture approach prior to ethanol injection. Total of 87 core-removed guide wires (arrows) were placed into outflow vein. Patient complained of discomfort due to mass effect of guide wires after completion of embolization and two months later, patient underwent surgical removal of arteriovenous malformation containing guide wires without any complications.
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Figure 3: 28-year-old man with painful pulsating mass in left shoulder (patient 8).A, B. Arterial (A) and venous (B) phases of pretreatment posteroanterior angiogram show multiple feeding arteries (arrowheads) and huge dilated outflow vein (arrows). Note coil (open arrow) that was previously placed into feeding artery at another hospital.C. Arterial phase of left anterior oblique angiogram shows complete obliteration of arteriovenous malformations after three sessions of embolization with 40 mL, 55 mL, and 16 mL of absolute ethanol, respectively, by using direct puncture of dilated outflow vein. In every session, multiple core-removed guide wires were placed into outflow vein through direct puncture approach prior to ethanol injection. Total of 87 core-removed guide wires (arrows) were placed into outflow vein. Patient complained of discomfort due to mass effect of guide wires after completion of embolization and two months later, patient underwent surgical removal of arteriovenous malformation containing guide wires without any complications.

Mentions: Ethanol embolization achieved an effective therapeutic outcome in all 19 patients. Thirteen (68%) of the 19 patients were cured, and there was no evidence of recurrence at imaging and clinical follow-up. In the two patients that were cured (patients 8 and 13) who underwent ethanol and core-removed guide wire embolization, devascularized AVMs that contained coreremoved guide wires were surgically removed to reduce the mass effect of the guide wires, at one month and two months after completion of embolization, respectively (Fig. 3). Three of the six patients with improvement, in whom clinical symptoms and signs were completely resolved and ≥ 75% of the AVMs were devascularized, finished treatment as the small residual AVMs were difficult to access or treat safely. The other three patients with improvement, in whom clinical symptoms and signs remained, were waiting for further sessions of ethanol embolization to treat the residual AVMs.


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)

28-year-old man with painful pulsating mass in left shoulder (patient 8).A, B. Arterial (A) and venous (B) phases of pretreatment posteroanterior angiogram show multiple feeding arteries (arrowheads) and huge dilated outflow vein (arrows). Note coil (open arrow) that was previously placed into feeding artery at another hospital.C. Arterial phase of left anterior oblique angiogram shows complete obliteration of arteriovenous malformations after three sessions of embolization with 40 mL, 55 mL, and 16 mL of absolute ethanol, respectively, by using direct puncture of dilated outflow vein. In every session, multiple core-removed guide wires were placed into outflow vein through direct puncture approach prior to ethanol injection. Total of 87 core-removed guide wires (arrows) were placed into outflow vein. Patient complained of discomfort due to mass effect of guide wires after completion of embolization and two months later, patient underwent surgical removal of arteriovenous malformation containing guide wires without any complications.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: 28-year-old man with painful pulsating mass in left shoulder (patient 8).A, B. Arterial (A) and venous (B) phases of pretreatment posteroanterior angiogram show multiple feeding arteries (arrowheads) and huge dilated outflow vein (arrows). Note coil (open arrow) that was previously placed into feeding artery at another hospital.C. Arterial phase of left anterior oblique angiogram shows complete obliteration of arteriovenous malformations after three sessions of embolization with 40 mL, 55 mL, and 16 mL of absolute ethanol, respectively, by using direct puncture of dilated outflow vein. In every session, multiple core-removed guide wires were placed into outflow vein through direct puncture approach prior to ethanol injection. Total of 87 core-removed guide wires (arrows) were placed into outflow vein. Patient complained of discomfort due to mass effect of guide wires after completion of embolization and two months later, patient underwent surgical removal of arteriovenous malformation containing guide wires without any complications.
Mentions: Ethanol embolization achieved an effective therapeutic outcome in all 19 patients. Thirteen (68%) of the 19 patients were cured, and there was no evidence of recurrence at imaging and clinical follow-up. In the two patients that were cured (patients 8 and 13) who underwent ethanol and core-removed guide wire embolization, devascularized AVMs that contained coreremoved guide wires were surgically removed to reduce the mass effect of the guide wires, at one month and two months after completion of embolization, respectively (Fig. 3). Three of the six patients with improvement, in whom clinical symptoms and signs were completely resolved and ≥ 75% of the AVMs were devascularized, finished treatment as the small residual AVMs were difficult to access or treat safely. The other three patients with improvement, in whom clinical symptoms and signs remained, were waiting for further sessions of ethanol embolization to treat the residual AVMs.

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